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

1. A 32-year-old woman presented at 34 weeks of pregnancy, after an episode of vaginal bleeding. Gestational diabetes had been diagnosed at 28 weeks and insulin was started at 29 weeks. Her pre-pregnancy body mass index was 32 kg/m2 (18-25) and there was no family history of diabetes. She was treated with betamethasone 12 mg over 2 days. She was taking 60 units of insulin subcutaneously daily (40 units prandial in three divided doses, and 20 units intermediate-acting insulin), which had been unchanged for 3 weeks.
On examination, she was apyrexial, her pulse was 96 beats per minute and her blood pressure was 124/74 mmHg. Urinalysis showed blood 1+, protein 1+, glucose 2+, ketones 3+.
Investigations:
serum sodium134 mmol/L (137-144)
serum potassium3.8 mmol/L (3.5-4.9)
serum chloride105 mmol/L (95-107) serum urea5.0 mmol/L (2.5-7.0) serum creatinine90 umol/L (60-110) random plasma glucose7.2 mmol/L
What is the most appropriate next step in management?

A) start intravenous insulin
B) continue to monitor blood glucose in hospital
C) discharge and monitor blood glucose at home
D) increase subcutaneous insulin doses by 2-4 units
E) measure venous bicarbonate

2. A 34-year-old woman with Addison's disease reported four adrenal crises over the preceding 6 months, requiring hospital admission and intravenous administration of hydrocortisone. At outpatient follow-up, she was taking hydrocortisone 15 mg in the morning and 10 mg at midday, and fludrocortisone 50 micrograms daily.
What is the most important next step in management to prevent further crises?

A) increase dosage of hydrocortisone
B) measure plasma adrenocorticotropic hormone
C) change to sustained-release hydrocortisone
D) measure plasma renin
E) measure post-dose 09.00 h cortisol

3. A 16-year-old boy was referred to the endocrine clinic with symptoms of delayed puberty.
On examination, he had a reduced sense of smell, small-sized testes and underdeveloped
secondary sexual characteristics.
Investigations:
serum testosterone3.5 nmol/L (9.0-35.0)
serum follicle-stimulating hormone1.0 U/L (1.0-7.0)
serum luteinising hormone1.5 U/L (1.0-10.0)
serum prolactin220 mU/L (<360)
MR scan of brainnormal
He asked about his future fertility.
What will be the most useful agent for him to achieve fertility?

A) clomifene
B) gonadotropin-releasing hormones
C) octreotide
D) bromocriptine
E) testosterone

4. A 61-year-old woman was referred to the blood pressure clinic because of refractory hypertension. One year previously, her blood pressure, urea and electrolytes had been normal. Her current therapy included verapamil modified-release 240 mg daily and doxazosin 16 mg daily.
On examination, she was 1.63 m tall and weighed 90 kg with an elevated waist to hip ratio. Her blood pressure was 182/94 mmHg supine.
Investigations:
serum sodium137 mmol/L (137-144)
serum potassium2.8 mmol/L (3.5-4.9)
serum creatinine79 umol/L (60-110)
plasma renin activity (after 30 min supine)<1.1 pmol/mL/h (1.1-2.7)
plasma aldosterone (after 30 min supine)<135 pmol/L (135-400)
What is the most appropriate investigation?

A) overnight dexamethasone suppression test
B) 24-h urine to assess free cortisol:cortisone ratio
C) 24-h urinary electrolytes
D) repeat renin and aldosterone concentrations after stopping verapamil for 2 weeks
E) analysis of the SCNN1B and SCNN1G genes

5. A 33-year-old woman, who was 9 weeks into her first pregnancy, was admitted with prolonged vomiting and secondary dehydration. She had lost 6 kg in weight since becoming pregnant. There was a strong family history of thyroid disease: two sisters were hypothyroid and one brother had required radioactive iodine for Graves' disease.
On examination, she had a smooth, small goitre. Her pulse was 94 beats per minute and her blood pressure was 104/42 mmHg. There was a tremor of the outstretched hands. Urinalysis was normal.
Investigations:
serum sodium143 mmol/L (137-144) serum potassium4.4 mmol/L (3.5-4.9)
serum creatinine105 umol/L (60-110)
serum thyroid-stimulating hormone (TSH)<0.01 mU/L (0.4-5.0)
serum free T424.0 pmol/L (10.0-22.0)
serum free T311.0 pmol/L (3.0-7.0)
A TSH receptor antibody concentration was awaited.
In addition to rehydration, what is the most appropriate next step in the management of her abnormal thyroid function?

A) carbimazole
B) propranolol
C) observation
D) labetalol
E) propylthiouracil

Solutions: