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

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

2. A 46-year-old South Asian man presented with a 2-month history of dry mouth and polyuria. He had hypertension treated with bendroflumethiazide. There was no family history of diabetes mellitus, but his father had died suddenly during lower limb angioplasty at the age of 51.
On examination, the patient's pulse was 76 beats per minute and regular, and his blood pressure was 164/86 mmHg. The rest of the physical examination was normal. Urinalysis was normal.
Investigations:
serum sodium143 mmol/L (137-144)
serum potassium3.0 mmol/L (3.5-4.9)
serum creatinine123 umol/L (60-110)
fasting plasma glucose6.9 mmol/L (3.0-6.0)
What is the most appropriate next step in management?

A) repeat fasting plasma glucose
B) haemoglobin A1c measurement
C) start oral hypoglycaemic treatment
D) change bendroflumethiazide to ramipril
E) oral glucose tolerance test

3. A 35-year-old man presented with newly diagnosed type 2 diabetes mellitus. He had no medical history of note.
When should he inform the UK Driver and Vehicle Licensing Agency (DVLA) of his medical condition?

A) if he becomes unable to read a car number plate with one eye at 20.5 m
B) if he starts taking an oral hypoglycaemic agent
C) immediately
D) if he requires laser treatment to one eye
E) if he starts using basal night-time insulin

4. A 70-year-old man was admitted after the gradual development of confusion. He had no
significant medical history.
Examination was otherwise normal.
Investigations:
serum sodium110 mmol/L (137-144)
serum potassium3.8 mmol/L (3.5-4.9)
serum creatinine50 umol/L (60-110)
He was treated with several litres of sodium chloride 0.9% over the subsequent few days, resulting in a rapid restoration of serum sodium to the normal range. This coincided with the development of limb weakness and spasticity that became permanent.
The movement of what substance(s) between the intracellular fluid compartment (ICF) and extracellular fluid compartment (ECF) explains the changes in this patient?

A) sodium from ECF to ICF
B) sodium and water from ECF to ICF
C) sodium from ICF to ECF
D) water from ECF to ICF
E) water from ICF to ECF

5. A 55-year-old woman presented complaining of difficulty losing weight.
On examination, her blood pressure was 170/105 mmHg and urinalysis showed protein 1+.
An ultrasound scan of abdomen revealed a 4.5-cm solid lesion in the right adrenal gland. She was treated with ramipril and further endocrine evaluation was performed.
Investigations:
serum potassium3.6 mmol/L (3.5-4.9)
serum creatinine135 umol/L (60-110)
plasma renin activity:
(after 30 min supine)3.9 pmol/mL/h (1.1-2.7)
(after 30 min upright)6.8 pmol/mL/h (3.0-4.3)
plasma aldosterone:
(after 30 min supine)150 pmol/L (135-400)
(after 4 h upright)350 pmol/L (330-830)
serum cortisol (09.00 h)650 nmol/L (200-700)
serum cortisol (22.00 h)225 nmol/L (50-250)
24-h urinary free cortisol230 nmol (55-250)
24-h urinary dopamine3200 nmol (<3100)
24-h urinary adrenaline120 nmol (<144)
24-h urinary noradrenaline450 nmol (<570)
What is the most appropriate initial management of the adrenal lesion?

A) surgical excision
B) angiotensin-2 receptor blockade
C) ?-adrenoceptor blockade
D) medical observation with annual ultrasonography
E) mineralocorticoid receptor blockade

Solutions: