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

1. A 64-year-old man presented with palpitations, fatigue and malaise. Two months previously, he had sustained an acute myocardial infarction complicated by ventricular tachycardia and cardiac arrest, and had been discharged taking amiodarone 200 mg daily.
On examination, he appeared well, his pulse was 90 beats per minute and regular, and he
had mild tremor of his hands but no other abnormal signs.
Investigations:
serum thyroid-stimulating hormone6.2 mU/L (0.4-5.0)
serum free T418.2 pmol/L (10.0-22.0)
serum free T34.8 pmol/L (3.0-7.0)
What is the most appropriate next step in management?

A) repeat thyroid function tests in 2 months
B) repeat thyroid function tests in 12 months
C) start levothyroxine
D) discontinue amiodarone
E) isotope scan of thyroid

2. A 41-year-old man presented to his general practitioner with symptoms of palpitations, sweating and anxiety. His blood pressure was 160/102 mmHg. He was advised to take propranolol 40 mg twice daily but was admitted to hospital later that week with an episode of pulmonary oedema.
On examination at the time of admission, he was noted to be pale and sweating and he had a blood pressure of 210/124 mmHg. A phaeochromocytoma was suspected.
What is the most likely cause of the cardiovascular deterioration following administration of propranolol?

A) propranolol acting as an agonist at ?1-adrenoceptors
B) inhibition of catechol-O-methyltransferase by propranolol leading to an increase in circulating noradrenaline
C) ?1-adrenoceptor blockade leading to acute left ventricular dysfunction
D) inadequate ?-adrenoceptor blockade because of the short half-life of the drug
E) loss of ?2-adrenoceptor-mediated vasodilatation

3. A 27-year-old woman presented with oligomenorrhoea and hirsutism, and a 2-year history of infertility. Her body mass index was 26 kg/m2 (18-25). Her partner had a recent normal sperm count and motility test.
Investigations:
serum androstenedione17.0 nmol/L (0.6-8.8)
serum 17-hydroxyprogesterone2 nmol/L (1-10)
serum testosterone2.8 nmol/L (0.5-3.0)
serum sex hormone binding globulin18 nmol/L (40-137)
serum follicle-stimulating hormone2.3 U/L (2.5-10.0)
serum luteinising hormone8.3 U/L (2.5-10.0)
serum prolactin152 mU/L (<360)
A diagnosis of polycystic ovary syndrome was made.
What is the most effective next step to help her conceive?

A) clomifene
B) in vitro fertilisation
C) orlistat
D) metformin
E) diet and exercise

4. A 28-year-old woman was referred with an 8-year history of progressive weight gain, hypertension and abdominal striae. She had no family history of note and was not taking any medication.
On examination, her blood pressure was 158/86 mmHg. There was central obesity with abdominal striae. There was mild proximal myopathy of the lower limbs.
Investigations:
serum sodium143 mmol/L (137-144)
serum potassium3.4 mmol/L (3.5-4.9)
low-dose dexamethasone suppression test (2 mg/day for 48 h):
serum cortisol180 nmol/L (<50)
An MR scan of pituitary showed an invasive adenoma extending laterally into the cavernous sinuses bilaterally. Superiorly, the adenoma was in contact with, but not distorting, the optic chiasm. Formal visual field examination was normal.
What is the most appropriate next step in management?

A) pituitary radiotherapy
B) adrenolytic therapy
C) bilateral adrenalectomy
D) somatostatin agonist therapy
E) trans-sphenoidal hypophysectomy

5. A 55-year-old man with mild polyuria and tiredness was seen on a renal ward. He had had a living-related kidney transplant 6 months previously. He had good graft function while being treated with prednisolone 5 mg daily, mycophenolate mofetil 1 g twice daily and tacrolimus 3 mg twice daily. He was also taking atenolol 50 mg daily and simvastatin 40 mg daily.
Investigations:
haemoglobin A1c75 mmol/mol (20-42)
random plasma glucose18.0 mmol/L
Which drug is most likely to be responsible for his diabetes of new onset?

A) tacrolimus
B) simvastatin
C) prednisolone
D) mycophenolate mofetil
E) atenolol

Solutions: