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

1. A 17-year-old boy was concerned about his height. He had been treated for Crohn's disease since the age of 13 with a combination of topical and systemic corticosteroids and azathioprine. He was currently taking mercaptopurinE.
On examination, his height was on the 25th centile.
Investigations:
X-ray of right kneesee image

What is the most appropriate next step in management?

A) advise him that growth is complete
B) treat with growth hormone
C) investigate for growth hormone deficiency
D) refer for leg lengthening surgery
E) advise him that he will continue to grow for 12 months

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

3. A 63-year-old woman was incidentally found to have a 3-cm right adrenal mass on a CT scan of abdomen during investigation for abdominal pain. Her medical history included angina, hypertension and hypercholesterolaemia. She was taking oestrogen-containing hormone replacement therapy, atenolol, bendroflumethiazide, simvastatin and aspirin.
On examination, her pulse was 60 beats per minute and regular, and her blood pressure was 150/90 mmHg. She was obese with a body mass index of 34 kg/m2 (18-25). Fundoscopy revealed grade II hypertensive retinopathy.
Investigations:
serum sodium137 mmol/L (137-144)
serum potassium3.0 mmol/L (3.5-4.9)
serum creatinine100 umol/L (60-110)
plasma renin activity (after 30 min supine)0.4 pmol/mL/h (1.1-2.7)
plasma aldosterone (after 30 min supine)200 pmol/L (135-400)
overnight dexamethasone suppression test (after 1 mg dexamethasone):
serum cortisol75 nmol/L (<50)
24-h urinary free cortisol140 nmol (55-250)
24-h urinary metanephrine<1 umol (<2)
24-h urinary normetanephrine1 umol (<3)
What is the most likely cause of the hypertension?

A) phaeochromocytoma
B) Cushing's syndrome
C) Conn's syndrome
D) essential hypertension
E) renovascular disease

4. Five patients were referred to a rapid access thyroid clinic. Only four slots were available in the following month.
Which patient can safely be deferred to a later clinic?

A) 16-year-old boy with a thyroid nodule
B) 67-year-old man with a goitre and hoarseness
C) 44-year-old woman with a history of sudden-onset pain in a thyroid lump
D) 39-year-old woman with a slowly growing thyroid lump and a palpable cervical lymph node
E) 45-year-old woman with a rapidly enlarging painless goitre

5. A 58-year-old woman was referred with an incidental finding of mild hypercalcaemia. She had no relevant symptoms or significant medical history. She was taking no medication.
Investigations:
serum creatinine101 umol/L (60-110) serum corrected calcium2.71 mmol/L (2.20-2.60) serum alkaline phosphatase78 U/L (45-105)
plasma parathyroid hormone6.8 pmol/L (0.9-5.4) serum 25-OH-cholecalciferol76 nmol/L (45-90)
What is the most appropriate next investigation?

A) parathyroid isotope scan
B) calcium:creatinine clearance ratio
C) ultrasound scan of neck
D) calcium-sensing receptor gene mutation analysis
E) bone mineral density scan

Solutions: