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

1. A 43-year-old woman was admitted with right lower lobe pneumonia and was found to have atrial fibrillation. She had a history of bipolar disorder for which she was taking lithium. Her menstrual periods were normal.
Investigations on admission:
serum thyroid-stimulating hormone (TSH)0.98 mU/L (0.4-5.0)
serum free T428.1 pmol/L (10.0-22.0)
serum free T314.2 pmol/L (3.0-7.0)
Assay interference had been excluded.
Subsequent investigations:
serum sex hormone binding globulin64 nmol/L (40-137)
serum thyroid-hormone receptor ?-subunit0.8 IU/L (<1.0)
anti-thyroid peroxidase antibodiesnegative
What is the most likely diagnosis?

A) non-thyroidal illness (sick euthyroid syndrome)
B) TSHoma
C) surreptitious ingestion of thyroxine
D) lithium-induced hyperthyroidism
E) thyroid hormone resistance

2. A 32-year-old woman with a recurrent history of Graves' thyrotoxicosis was being considered for radioiodine treatment. However, she wanted to conceive again at some stage and asked how soon she could become pregnant.
After what minimum interval would it be safe for her to conceive again?

A) 2 months
B) 12 months
C) 6 months
D) 8 months
E) 4 months

3. A 54-year-old man was referred from the urology department with erectile dysfunction.
On examination, he had normal secondary sexual characteristics. Testicular volume was
estimated at 15 mL bilaterally.
Investigations:
random plasma glucose8.0 mmol/L
serum testosterone8.1 nmol/L (9.0-35.0) plasma follicle-stimulating hormone3.4 U/L (1.0-7.0) plasma luteinising hormone4.7 U/L (1.0-10.0) serum prolactin410 mU/L (<360)
What is the most appropriate next step in management?

A) serum testosterone (09.00 h)
B) prescribe sildenafil
C) prescribe testosterone replacement
D) check for macroprolactinaemia
E) fasting plasma glucose

4. A 48-year-old woman presented with a 2-year history of weight gain, easy bruising and
mood disturbance.
Investigations:
fasting plasma glucose6.9 mmol/L (3.0-6.0)
low-dose dexamethasone suppression test (2 mg/day for 48 h):
serum cortisol200 nmol/L (<50)
24-h urinary free cortisol (?3)670, 400 and 300 nmol (55-250)
plasma adrenocorticotropic hormone (09.00 h)25.0 pmol/L (3.3-15.4)
MR scan of pituitarynormal
What test is most likely to give a definitive diagnosis?

A) corticotropin-releasing hormone test
B) CT scan of chest
C) petrosal sinus sampling
D) high-dose dexamethasone suppression text (8 mg/day for 48 h)
E) octreotide scan

5. A 25-year-old man presented with a 2-month history of thirst and polyuria. He had minimal weight loss and his body mass index was 26 kg/m2 (18-25). He had had sensorineural deafness since childhood. There was a very strong family history of sensorineural deafness and type 2 diabetes mellitus.
Urinalysis showed no ketones.
Investigations:
random plasma glucose18.0 mmol/L
What is the most appropriate next step in management?

A) water deprivation test to assess posterior pituitary function
B) test for mitochondrial diabetes
C) genetic testing for maturity-onset diabetes of the young
D) test for HFE genotype
E) measurement of glutamic acid decarboxylase antibodies

Solutions: