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

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

2. A 66-year-old woman was admitted with carpopedal spasm. During the previous week she had had 2 days of diarrhoea following treatment with ciprofloxacin for a urinary tract infection. She had long-standing rheumatoid arthritis treated with prednisolone 5 mg daily, and was also taking alendronic acid, omeprazole and furosemide.
Investigations:
serum creatinine115 ?mol/L (60-110)
serum corrected calcium1.79 mmol/L (2.20-2.60)
serum alkaline phosphatase124 U/L (45-105)
serum magnesium0.26 mmol/L (0.75-1.05)
plasma parathyroid hormone2.7 pmol/L (0.9-5.4)
Which medicine is most likely to be responsible for her metabolic derangement?

A) omeprazole
B) ciprofloxacin
C) furosemide
D) prednisolone
E) alendronic acid

3. A 49-year-old woman presented with a mass in her neck that was causing no specific symptoms.
Examination revealed a solitary nodule in the right thyroid lobe, with no associated lymphadenopathy. Thyroid function was normal. No other abnormality was noted. There was no evidence of lymphadenopathy in the neck.
Investigations:
ultrasound scan of necksolid hypoechoic nodule 1.8 ? 1.2 ? 1 cm
in right thyroid lobe;
cyst 0.6 ? 0.3 ? 0.2 cm in left thyroid lobe
cytology (fine-needle aspirationscanty colloid with abundant
from nodule in right lobe)thyroid follicular cells (Thy3f)
What is the most appropriate next step in management?

A) repeat cytology for confirmation
B) reassure that the nodule is not malignant and discharge
C) serum thyroglobulin
D) total thyroidectomy for histological diagnosis
E) thyroid lobectomy for histological diagnosis

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

5. A 56-year-old woman presented with a swelling in her neck, which she had noticed by chance 6 weeks previously. The swelling had not changed in size since she first noticed it, and was completely asymptomatic.
On examination, there was a smooth nodule in the thyroid that moved up on swallowing and there was no lymphadenopathy.
Investigations:
ultrasound scan of thyroidsingle 4.7-cm hypoechoic nodule
in upper left lobe
serum thyroid-stimulating hormone0.8 mU/L (0.4-5.0)
What is the most appropriate next step in management?

A) hemithyroidectomy
B) serial ultrasound examinations
C) fine-needle aspiration for cytology
D) FDG-PET CT scan
E) isotope uptake scan

Solutions: