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MRCPUK Endocrinology and Diabetes (Specialty Certificate Examination) Sample Questions:

1. A 42-year-old woman presented with a 6-month history of tiredness. She also had a history of hypothyroidism, for which she was taking levothyroxine 150 micrograms daily, and a family history of hyperactivity syndrome.
Examination was normal.
Investigations:
serum thyroid-stimulating hormone12.3 mU/L (0.4-5.0)
serum free T418.0 pmol/L (10.0-22.0)
What is the most likely diagnosis?

A) pituitary thyrotroph adenoma
B) non-adherence with thyroid hormone treatment
C) suboptimal prescribed dose of levothyroxine
D) levothyroxine malabsorption
E) thyroid hormone resistance

2. A 37-year-old woman was seen in clinic with a 2-month history of mild galactorrhoea. She had a long-standing history of hypothyroidism, treated with levothyroxine 125 micrograms daily, and a history of mental health issues, treated with risperidone. Her menstrual cycle was regular.
An MR scan of brain, requested elsewhere as part of a workup for headaches and other somatic symptoms, was available.
Investigations:
serum prolactin3000 mU/L (<360)
serum thyroid-stimulating hormone4.8 mU/L (0.4-5.0)
serum free T411.0 pmol/L (10.0-22.0)
MR scan of brainno abnormalities reported
What is the most appropriate next step in the management of her hyperprolactinaemia?

A) MR scan of pituitary fossa
B) stop risperidone
C) increase levothyroxine dosage
D) add cabergoline
E) reassurance of no significant pituitary pathology

3. A 17-year-old boy was concerned about his height. He had been treated for Crohn's disease since the age of 13 with a combination of topical and systemic corticosteroids and azathioprine. He was currently taking mercaptopurinE.
On examination, his height was on the 25th centile.
Investigations:
X-ray of right kneesee image

What is the most appropriate next step in management?

A) refer for leg lengthening surgery
B) advise him that growth is complete
C) treat with growth hormone
D) investigate for growth hormone deficiency
E) advise him that he will continue to grow for 12 months

4. A 78-year-old man presented with confusion, lethargy and thirst. He had hypertension treated with lisinopril 20 mg daily.
On examination, he was dehydrated. His pulse was 110 beats per minute and his blood pressure was 84/40 mmHg. Urinalysis showed ketones 1+.
Investigations:
serum sodium155 mmol/L (137-144) serum potassium5.2 mmol/L (3.5-4.9) serum bicarbonate17 mmol/L (20-28) serum urea40.0 mmol/L (2.5-7.0)
serum creatinine358 umol/L (60-110) random plasma glucose78.0 mmol/L He was treated with sodium chloride 0.9%. After 8 hours' treatment, his urine output was
10 mL/h and his blood pressure was 121/50 mmHg. Investigations (after 8 hours' treatment): serum sodium151 mmol/L (137-144)
serum potassium4.9 mmol/L (3.5-4.9) serum bicarbonate18 mmol/L (20-28) serum urea39.0 mmol/L (2.5-7.0) serum creatinine347 umol/L (60-110)
random plasma glucose48.0 mmol/L
What is the most appropriate next step in management?

A) compound lactate solution (Hartmann's solution)
B) sodium chloride 0.18% and glucose 4%
C) sodium chloride 0.18% and glucose 5%
D) sodium chloride 0.45%
E) sodium chloride 0.9%

5. A 28-year-old man was seen in the lipid clinic following a referral from the general surgical team. He had had two episodes of acute pancreatitis over the preceding 6 months, which settled spontaneously. He had a past medical history of HIV disease and was taking highly active antiretroviral (HAART) therapy. He drank 12 units of alcohol per week.
On examination, he had no stigmata of hyperlipidaemia.
Investigations:
fasting plasma glucose6.2 mmol/L (3.0-6.0)
haemoglobin A1c44 mmol/mol (20-42)
serum cholesterol7.5 mmol/L (<5.2)
fasting serum triglycerides23.70 mmol/L (0.45-1.69)
serum thyroid-stimulating hormone0.7 mU/L (0.4-5.0)
serum free T414.3 pmol/L (10.0-22.0)
What class of antiretroviral drug is the most likely cause of his metabolic disturbance?

A) non-nucleoside reverse transcriptase inhibitors (e.g. nevirapine)
B) entry inhibitors (e.g. enfuvirtide)
C) protease inhibitors (e.g. ritonavir)
D) integrase inhibitors (e.g. raltegravir)
E) nucleoside reverse transcriptase inhibitors (e.g. zidovudine)

Solutions: