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

1. A 26-year-old woman with previously well-controlled primary hypothyroidism had been an in patient for treatment of an eating disorder for the previous 6 weeks. She had a history of anaemia resulting from multiple vitamin deficiency and gastric erosions. She had been taking levothyroxine 125 micrograms daily for the previous 5 years; since admission her medication had also included ferrous sulfate, calcium and vitamin D, and sucralfate. Her daily medicines were taken under supervision at 09.00 h. Although she was eating better and had gained 4 kg in weight, she was now complaining of tiredness and feeling "worse than ever".
On examination, she was thin, slightly pale and had no palpable goitre. Recent blood tests had confirmed that her anaemia had resolved.
Investigations:
serum corrected calcium2.28 mmo/L (2.20-2.60)
serum thryoid-stimulating hormone12.0 mU/L (0.4-5.0)
serum free T48.0 pmol/L (10.0-22.0)
serum T30.90 nmol/L (1.07-3.18)
What is the most appropriate next step in management?

A) increase levothyroxine to 175 micrograms daily
B) administer levothyroxine alone at bedtime
C) no change in treatment
D) stop treatment with calcium and vitamin D
E) add liothyronine 20 micrograms daily

2. A 28-year-old Asian woman was seen in the joint diabetes-antenatal clinic at 16 weeks' gestation. She gave a history of gestational diabetes during her previous pregnancy. She had a strong family history of diabetes mellitus. She was fit and well, and had no symptoms other than slight early morning sickness.
According to NICE guidance (NG3, February 2015) for management of pregnancy, what is the most appropriate way to screen for gestational diabetes in this woman?

A) oral glucose tolerance test as soon as possible
B) fasting plasma glucose
C) haemoglobin A1c
D) oral glucose tolerance test at 24-28 weeks' gestation
E) 2-h postprandial plasma glucose

3. Five patients were referred to a rapid access thyroid clinic. Only four slots were available in the following month.
Which patient can safely be deferred to a later clinic?

A) 39-year-old woman with a slowly growing thyroid lump and a palpable cervical lymph node
B) 67-year-old man with a goitre and hoarseness
C) 16-year-old boy with a thyroid nodule
D) 44-year-old woman with a history of sudden-onset pain in a thyroid lump
E) 45-year-old woman with a rapidly enlarging painless goitre

4. A 56-year-old man was referred urgently by an ophthalmologist after presenting with a 6month history of deteriorating vision. The patient had a 40 pack-year smoking history. Before his vision problem, he had never visited his general practitioner.
Investigations:
serum cortisol (09.00 h)389 nmol/L (200-700) serum testosterone8.6 nmol/L (9.0-35.0) plasma follicle-stimulating hormone2.1 U/L (1.0-7.0) plasma luteinising hormone2.4 U/L (1.0-10.0) serum prolactin896 mU/L (<360) serum thyroid-stimulating hormone1.4 mU/L (0.4-5.0)
MR scan of pituitarysee image

What is the most likely diagnosis?

A) Rathke's cyst
B) meningioma
C) prolactinoma
D) non-functioning adenoma
E) craniopharyngioma

5. A 54-year-old woman was referred for assessment of low bone mineral density. Three months previously, after complaining of bloating and flatulence, she had been found to have coeliac disease and had been started on a gluten-free diet. She had no history of fracture and had not lost height. There was no family history of osteoporosis. Her only medication was omeprazole.
Investigations:
serum corrected calcium2.42 mmol/L (2.20-2.60) serum alkaline phosphatase122 U/L (45-105)
plasma parathyroid hormone7.9 pmol/L (0.9-5.4)
DXA scansee image What is the most appropriate treatment?

A) calcium and vitamin D
B) alendronic acid, and calcium and vitamin D
C) alendronic acid alone
D) calcium and vitamin D, and intravenous zoledronic acid
E) strontium ranelate

Solutions: