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

1. A 62-year-old man was referred from the infectious diseases clinic. He had HIV infection and was taking treatment that included thymidine analogue nucleoside reverse transcriptase inhibitors. He had developed considerable loss of limb and gluteal subcutaneous fat. He had complained recently of polyuria and polydipsia and was found to have a fasting plasma glucose of 8.3 mmol/L (3.0-6.0).
What is the most appropriate treatment for his diabetes mellitus?

A) gliclazide
B) pioglitazone
C) exenatide
D) metformin
E) insulin

2. A 17-year-old girl was referred to the transition clinic. She was taking hydrocortisone 10 mg twice daily and fludrocortisone 150 micrograms daily following a failed short tetracosactide (Synacthen@) test 5years previously. She had entered puberty at the age of 10 but had never achieved adult breast development or menarche.
Investigations:
haemoglobin95 g/L (115-165)
MCV124 fL (80-96)
white cell count8.4 ? 109/L (4.0-11.0)
platelet count334 ? 109/L (150-400)
serum sodium138 mmol/L (137-144)
serum potassium4.4 mmol/L (3.5-4.9)
serum urea3.5 mmol/L (2.5-7.0)
serum corrected calcium1.80 mmol/L (2.20-2.60)
serum follicle-stimulating hormone67.9 U/L (2.5-10.0)
serum luteinising hormone56.4 U/L (2.5-10.0)
What is the most likely diagnosis?

A) atypical congenital adrenal hyperplasia
B) Turner's syndrome
C) pituitary stalk interruption syndrome
D) autoimmune polyglandular syndrome type 1
E) hypothalamic germinoma

3. A 29-year-old woman presented with primary infertility, having had unprotected sexual intercourse for 15 months. Menarche had occurred at the age of 13.5 years. Her menstrual cycle was irregular, occurring every 20-60 days. There was no history of galactorrhoea. She denied abnormal hair growth.
On examination, her body mass index was 28.9 kg/m2 (18-25) and she had normal secondary sexual characteristics. Her visual fields were full to confrontation.
Investigations:
serum androstenedione12.8 nmol/L (0.6-8.8)
serum oestradiol205 pmol/L (200-400)
serum testosterone2.4 nmol/L (0.5-3.0)
serum sex hormone binding globulin23 nmol/L (40-137)
serum follicle-stimulating hormone4.3 U/L (2.5-10.0)
serum luteinising hormone8.5 U/L (2.5-10.0)
serum prolactin420 mU/L (<360)
hysterosalpingogrampatent fallopian tubes
partner's semen analysisnormal sperm count and motility
What is the most appropriate first-line intervention?

A) cabergoline
B) human menopausal gonadotropins
C) orlistat
D) human chorionic gonadotropin
E) metformin

4. A 56-year-old woman presented with a swelling in her neck, which she had noticed by chance 6 weeks previously. The swelling had not changed in size since she first noticed it, and was completely asymptomatic.
On examination, there was a smooth nodule in the thyroid that moved up on swallowing and there was no lymphadenopathy.
Investigations:
ultrasound scan of thyroidsingle 4.7-cm hypoechoic nodule
in upper left lobe
serum thyroid-stimulating hormone0.8 mU/L (0.4-5.0)
What is the most appropriate next step in management?

A) hemithyroidectomy
B) isotope uptake scan
C) FDG-PET CT scan
D) fine-needle aspiration for cytology
E) serial ultrasound examinations

5. A 40-year-old man presented with a 4-month history of increasing central obesity. His medical history included HIV infection and allergic rhinitis. He was taking highly active antiretroviral therapy and nasal fluticasone.
On examination, he had marked central adiposity. His blood pressure was 160/95 mmHg.
Investigations:
serum sodium140 mmol/L (137-144)
serum potassium3.8 mmol/L (3.5-4.9)
serum cholesterol5.5 mmol/L (<5.2)
fasting serum triglycerides8.20 mmol/L (0.45-1.69)
serum cortisol (09.00 h)<50 nmol/L (200-700)
serum thyroid-stimulating hormone4.6 mU/L (0.4-5.0)
serum free T49.3 pmol/L (10.0-22.0)
What is the most likely diagnosis?

A) Cushing's syndrome
B) hypothyroidism
C) glucocorticoid resistance
D) HIV-associated lipodystrophy
E) Addison's disease

Solutions: