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

1. A 35-year-old woman was referred with a left lower thyroid lesion. She was asymptomatic.
Examination confirmed the presence of a 2 ? 3-cm, firm, mobile, non-tender mass.
Investigations:
ultrasound-guided fine-needle aspiration biopsyThy 5
How is Thy 5 defined?

A) non-diagnostic or inadequate
B) non-neoplastic (consistent with nodular goitre or thyroiditis)
C) follicular lesions
D) abnormal, suspicious (but not diagnostic of) malignancy
E) abnormal, diagnostic of malignancy

2. A 26-year-old man presented urgently, complaining of muscle pains. He had been found to have heterozygous familial hypercholesterolaemia 2 years previously owing to a mutation in the PCSK9 gene. He had a strong family history of premature vascular disease. He was taking atorvastatin 80 mg daily.
Investigations:
serum creatine kinase2782 U/L (24-195)
serum cholesterol5.7 mmol/L (<5.2)
After stopping atorvastatin, his serum creatine kinase fell to within the normal range.
What is the most appropriate next step in management?

A) start fluvastatin 40 mg
B) start fenofibrate 100 mg
C) restart atorvastatin 10 mg
D) start ezetimibe 10 mg
E) restart atorvastatin 40 mg

3. A 43-year-old woman was admitted with right lower lobe pneumonia and was found to have atrial fibrillation. She had a history of bipolar disorder for which she was taking lithium. Her menstrual periods were normal.
Investigations on admission:
serum thyroid-stimulating hormone (TSH)0.98 mU/L (0.4-5.0)
serum free T428.1 pmol/L (10.0-22.0)
serum free T314.2 pmol/L (3.0-7.0)
Assay interference had been excluded.
Subsequent investigations:
serum sex hormone binding globulin64 nmol/L (40-137)
serum thyroid-hormone receptor ?-subunit0.8 IU/L (<1.0)
anti-thyroid peroxidase antibodiesnegative
What is the most likely diagnosis?

A) TSHoma
B) lithium-induced hyperthyroidism
C) surreptitious ingestion of thyroxine
D) non-thyroidal illness (sick euthyroid syndrome)
E) thyroid hormone resistance

4. A 55-year-old woman presented complaining of difficulty losing weight.
On examination, her blood pressure was 170/105 mmHg and urinalysis showed protein 1+.
An ultrasound scan of abdomen revealed a 4.5-cm solid lesion in the right adrenal gland. She was treated with ramipril and further endocrine evaluation was performed.
Investigations:
serum potassium3.6 mmol/L (3.5-4.9)
serum creatinine135 umol/L (60-110)
plasma renin activity:
(after 30 min supine)3.9 pmol/mL/h (1.1-2.7)
(after 30 min upright)6.8 pmol/mL/h (3.0-4.3)
plasma aldosterone:
(after 30 min supine)150 pmol/L (135-400)
(after 4 h upright)350 pmol/L (330-830)
serum cortisol (09.00 h)650 nmol/L (200-700)
serum cortisol (22.00 h)225 nmol/L (50-250)
24-h urinary free cortisol230 nmol (55-250)
24-h urinary dopamine3200 nmol (<3100)
24-h urinary adrenaline120 nmol (<144)
24-h urinary noradrenaline450 nmol (<570)
What is the most appropriate initial management of the adrenal lesion?

A) angiotensin-2 receptor blockade
B) medical observation with annual ultrasonography
C) ?-adrenoceptor blockade
D) mineralocorticoid receptor blockade
E) surgical excision

5. A 17-year-old girl with Turner's syndrome attended the clinic for review. She had been treated with growth hormone therapy for the previous 7 years, and had now reached her final adult height.
What is the most appropriate next step in management?

A) start to reduce growth hormone therapy with a view to discontinuing in 2 years' time
B) withdraw growth hormone therapy for 3 months and evaluate growth hormone secretion
C) stop growth hormone therapy
D) assess her bone density by DXA scan and continue growth hormone if bone mineral density is less than mean for age
E) continue growth hormone until 25 years old then reassess

Solutions: