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

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

2. A 54-year-old man was referred from the urology department with erectile dysfunction.
On examination, he had normal secondary sexual characteristics. Testicular volume was
estimated at 15 mL bilaterally.
Investigations:
random plasma glucose8.0 mmol/L
serum testosterone8.1 nmol/L (9.0-35.0) plasma follicle-stimulating hormone3.4 U/L (1.0-7.0) plasma luteinising hormone4.7 U/L (1.0-10.0) serum prolactin410 mU/L (<360)
What is the most appropriate next step in management?

A) check for macroprolactinaemia
B) fasting plasma glucose
C) prescribe sildenafil
D) prescribe testosterone replacement
E) serum testosterone (09.00 h)

3. A 55-year-old woman presented with thirst, polyuria and polydipsia. Her symptoms had started 9 months previously following a road traffic accident. Her past medical history was normal and she was not taking any regular medication.
On examination, her blood pressure was 130/80 mmHg with no postural drop. Urine volume measured 5 L in 24 hours.
Investigations:
serum sodium131 mmol/L (137-144) serum potassium3.6 mmol/L (3.5-4.9) serum urea2.0 mmol/L (2.5-7.0) serum corrected calcium2.40 mmol/L (2.20-2.60) fasting plasma glucose6.4 mmol/L (3.0-6.0) serum osmolality278 mosmol/kg (278-300) urinary osmolality100 mosmol/kg (100-1000)
What is the most likely diagnosis?

A) syndrome of inappropriate antidiuretic hormone
B) nephrogenic diabetes insipidus
C) cranial diabetes insipidus
D) primary polydipsia
E) diabetes mellitus

4. A 20-year-old woman with Turner's syndrome had heard that there was a risk of ovarian cancer associated with Turner's syndrome. She asked to undergo a pre-emptive oophorectomy.
For what genotype is oophorectomy most likely to be recommended?

A) 45XO
B) 45X/47XXX
C) 45X/46Xxi (Xq)
D) 45X/46XX
E) 45X/46XY

5. A 16-year-old boy was referred to the diabetes clinic following the discovery of a random plasma glucose concentration of 18.0 mmol/L. His general practitioner had begun treatment with metformin. The patient had a body mass index of 35 kg/m2 (18-25). He had had problems throughout his childhood, and had been taken out of school and was educated at home by his mother. He was attending the ophthalmology clinic for visual problems.
On examination, he was obese. He had hearing aids in both ears and evidence of acanthosis nigricans. Neither parent had a history of diabetes mellitus.
What is the most likely diagnosis?

A) Bardet-Biedl syndrome
B) mitochondrial diabetes
C) Alstrom's syndrome
D) type 2 diabetes mellitus
E) hepatocyte nuclear factor 1? mutation

Solutions: