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

1. A 26-year-old woman was referred by her general practitioner for the management of subfertility. Her menarche had occurred at the age of 14 and she had experienced oligomenorrhoea since the age of 16. She also complained of gradually worsening hirsutism since puberty.
Clinical examination showed central obesity, a body mass index of 32 kg/m2 (18-25) and a blood pressure of 140/90 mmHg.
The following results were obtained within 1 week of her last menstrual period.
Investigations:
overnight dexamethasone suppression test (after 1 mg dexamethasone):
serum cortisol30 nmol/L (<50)
serum dehydroepiandrosterone sulphate12 umol/L (3-12)
serum androstenedione10.0 nmol/L (0.6-8.8)
serum 17-hydroxyprogesterone38 nmol/L (1-10)
serum oestradiol200 pmol/L (200-400)
serum testosterone3.5 nmol/L (0.5-3.0)
serum sex hormone binding globulin30 nmol/L (40-137)
plasma follicle-stimulating hormone4.0 U/L (2.5-10.0)
plasma luteinising hormone6.0 U/L (2.5-10.0)
What is the most likely diagnosis?

A) polycystic ovary syndrome
B) Cushing's syndrome
C) ovarian androgen-secreting tumour
D) adrenal androgen-secreting tumour
E) late-onset congenital adrenal hyperplasia

2. A 37-year-old man, who had previously undergone female-to-male gender reassignment surgery, attended the endocrine clinic for annual review. He had no complaints and was happy with the results of his treatment. His medication consisted of testosterone undecanoate 1 g intramuscularly every 3 months.
What variable is it most important to monitor?

A) haematocrit
B) serum prostate-specific antigen
C) serum testosterone
D) serum luteinising hormone
E) fasting plasma glucose

3. A 52-year-old woman had been found to have type 2 diabetes mellitus approximately 6
months previously.
Investigations:
haemoglobin A1c50 mmol/mol (20-42)
What is the lifetime risk of her identical twin sister also developing type 2 diabetes mellitus?

A) 20-30%
B) >60%
C) 40-50%
D) 5-10%
E) <5%

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

5. A 16-year-old girl presented with primary amenorrhoea. In early childhood she had undergone an inguinal herniorrhaphy. She had no other medical history of note. There was a family history of infertility affecting a maternal aunt.
On examination, she had adult breast development but no pubic or axillary hair. Examination was otherwise normal.
What test is most likely to aid diagnosis?

A) ultrasound scan of pelvis
B) MR scan of pituitary and olfactory bulbs
C) blood karyotype
D) plasma gonadotropins
E) ovarian antibody titres

Solutions: