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

1. A 37-year-old woman was seen in clinic with a 2-month history of mild galactorrhoea. She had a long-standing history of hypothyroidism, treated with levothyroxine 125 micrograms daily, and a history of mental health issues, treated with risperidone. Her menstrual cycle was regular.
An MR scan of brain, requested elsewhere as part of a workup for headaches and other somatic symptoms, was available.
Investigations:
serum prolactin3000 mU/L (<360)
serum thyroid-stimulating hormone4.8 mU/L (0.4-5.0)
serum free T411.0 pmol/L (10.0-22.0)
MR scan of brainno abnormalities reported
What is the most appropriate next step in the management of her hyperprolactinaemia?

A) increase levothyroxine dosage
B) reassurance of no significant pituitary pathology
C) add cabergoline
D) stop risperidone
E) MR scan of pituitary fossa

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

3. An 18-year-old man presented to the thyroid clinic complaining of a lump in his neck that had been present for 9 weeks. It was not painful. At the age of 12, he had developed acute lymphoblastic leukaemia and had undergone a bone marrow transplant preceded by total body irradiation and cyclophosphamide.
On examination, he was euthyroid. There was a 1.5-cm firm mass on the left side of the neck, which moved when he swallowed.
Investigations:
serum thyroid-stimulating hormone1.9 mU/L (0.4-5.0)
serum free T416.8 pmol/L (10.0-22.0)
What is the most appropriate initial course of action?

A) ultrasound-guided fine-needle aspiration of the nodule
B) surgical referral for hemithyroidectomy
C) technetium-99m scintigraphy scan of thyroid
D) FDG-PET-CT scan
E) CT scan of neck and thorax

4. An 18-year-old woman presented with a 2-month history of polyuria and polydipsia. She
had been previously fit and well with regular periods. She was not taking any contraception.
Investigations:
serum potassium5.2 mmol/L (3.5-4.9)
serum corrected calcium2.30 mmol/L (2.20-2.60)
serum cortisol (09.00 h)350 nmol/L (200-700)
She went on to have a water deprivation test, the results of which are detailed below.
time (h)serum osmolality (mosmol/kg)urine osmolality (mosmol/kg) normal: 278-300normal: 100-1000 08.3028952 11.3029282 14.30301153 15.30-172
She was then given intramuscular DDAVP@ 2 micrograms at 16.00 h.
time (h)serum osmolality (mosmol/kg)urine osmolality (mosmol/kg) normal: 278-300normal: 100-1000 16.3030017.30-530 18.30-532
Results from an MR scan of pituitary are shown (see image).

What is the most likely diagnosis?

A) psychogenic polydipsia
B) craniopharyngioma
C) Rathke's cleft cyst
D) non-functioning pituitary adenoma
E) autoimmune (lymphocytic) hypophysitis

5. A 23-year-old man presented with a history of discomfort with his gender for as long as he could remember. He believed he was transsexual.
What element of further history would most strongly support his self-diagnosis?

A) a long-standing intense wish to make his body conform to that of the preferred gender
B) conscious and absolute rejection of his sexual orientation as socially unacceptable
C) sexual excitement by cross-dressing
D) the presence of gender somatic delusions that emerge and strengthen with time
E) seeking medical rationalisation for sexuality through genital surgery

Solutions: