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

1. A 26-year-old woman with type 1 diabetes mellitus was seen in the antenatal diabetes clinic and was 8 weeks pregnant. The father of her child also had type 1 diabetes mellitus. They were concerned that their child might develop type 1 diabetes mellitus.
What is the likelihood of the child developing type 1 diabetes mellitus?

A) 0.1-1%
B) 85-100%
C) 55-75%
D) 25-40%
E) 5-10%

2. A 35-year-old woman was referred with a left lower thyroid lesion. She was asymptomatic.
Examination confirmed the presence of a 2 ? 3-cm, firm, mobile, non-tender mass.
Investigations:
ultrasound-guided fine-needle aspiration biopsyThy 5
How is Thy 5 defined?

A) abnormal, diagnostic of malignancy
B) follicular lesions
C) non-diagnostic or inadequate
D) abnormal, suspicious (but not diagnostic of) malignancy
E) non-neoplastic (consistent with nodular goitre or thyroiditis)

3. A 36-year-old woman was seen in the clinic with a recurrence of hyperthyroidism after a 2year remission. She had been treated with carbimazole for 18 months following her original presentation. She was moderately symptomatic and was keen to be treated in the same way again. She was planning a pregnancy.
Investigations: serum prolactin240 mU/L (<360) serum thyroid-stimulating hormone<0.1 mU/L (0.4-5.0) serum free T428.0 pmol/L (10.0-22.0)
anti-thyroid-stimulating hormone receptor antibodies44 U/L (<7)
What is the most appropriate next step in management?

A) block-and-replace treatment with carbimazole and levothyroxine
B) carbimazole
C) referral for thyroidectomy
D) propylthiouracil
E) radioiodine treatment

4. A 19-year-old man presented with late development of his pubic and axillary hair. He was otherwise well and was not taking any medication. His serum testosterone concentration had been normal on two previous occasions.
On examination, he now had post-pubertal secondary sexual characteristics. He had 15-20 mL testes.
Investigations:
serum testosterone27.0 nmol/L (9.0-35.0)
serum sex hormone binding globulin28 nmol/L (10-62)
serum follicle-stimulating hormone2.0 U/L (1.0-7.0)
serum luteinising hormone2.9 U/L (1.0-10.0)
What is the chief product of the Sertoli cell?

A) oestrogen
B) testosterone
C) serum sex hormone binding globulin
D) anti-Muellerian hormone
E) kisspeptin

5. A 54-year-old man on the neurosurgery unit developed hyponatraemia 3 days after presenting with a significant head injury. His Glasgow coma score (GCS) had been 6 on admission.
On examination, his GCS was 12. His blood pressure was 124/84 mmHg. There was no
oedema.
Investigations:
serum sodium118 mmol/L (137-144)
serum urea3.0 mmol/L (2.5-7.0)
serum creatinine72 umol/L (60-110)
random serum cortisol (08.00 h on day of review)480 nmol/L
serum thyroid-stimulating hormone1.2 mU/L (0.4-5.0)
random urinary sodium60 mmol/L
What is the most appropriate interpretation of these data?

A) the urinary sodium concentration is diagnostic of cerebral salt wasting
B) they are consistent with syndrome of inappropriate antidiuresis
C) a short tetracosactide (Synacthen@) test (250 micrograms) is required to exclude secondary hypoadrenalism
D) the diagnosis would be helped by measurement of plasma vasopressin concentration
E) intravascular volume depletion

Solutions: