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

1. A 56-year-old man attended routine follow-up for treatment of hypogonadism of late onset. His only medication was testosterone undecanoate (1 g intramuscular injection, every 12 weeks). He had started this treatment 12 months previously and last received the injection 1 week before review.
Digital rectal examination was normal.
Investigations (baseline): haemoglobin145 g/L (130-180) haematocrit0.46 (0.40-0.52) serum prostate-specific antigen0.6 ug/L (<4)
Investigations (12 months after treatment):
haemoglobin153 g/L (130-180) haematocrit0.51 (0.40-0.52) serum prostate-specific antigen5.1 ug/L (<4)
What is the most appropriate next step in management?

A) reassure and repeat blood tests in 12 months
B) refer for urological assessment
C) check serum testosterone
D) stop testosterone therapy
E) decrease testosterone injection frequency to 14 weeks

2. A 25-year-old man presented with a 2-month history of thirst and polyuria. He had minimal weight loss and his body mass index was 26 kg/m2 (18-25). He had had sensorineural deafness since childhood. There was a very strong family history of sensorineural deafness and type 2 diabetes mellitus.
Urinalysis showed no ketones.
Investigations:
random plasma glucose18.0 mmol/L
What is the most appropriate next step in management?

A) measurement of glutamic acid decarboxylase antibodies
B) water deprivation test to assess posterior pituitary function
C) test for HFE genotype
D) genetic testing for maturity-onset diabetes of the young
E) test for mitochondrial diabetes

3. A 62-year-old woman with persistent hypertension attended the clinic for review. She had no previous medical history of note and was taking amlodipine, ramipril, bendroflumethiazide, spironolactone and doxazosin. Her blood pressure was raised at 160/100 mmHg.
Investigations:
serum sodium138 mmol/L (137-144)
serum potassium3.8 mmol/L (3.5-4.9)
A blood test for renin and aldosterone concentration was being considered.
For what minimum period should spironolactone be discontinued before this test?

A) 1 week
B) 8 weeks
C) 6 weeks
D) 2 weeks
E) 72 h

4. A 24-year-old man was referred for investigation of infertility. He had been having unprotected intercourse with his partner for 18 months, but the couple had failed to conceive. He had been treated for Hodgkin's lymphoma at the age of 17.
What is the most appropriate investigation?

A) serum testosterone
B) serum inhibin
C) serum follicle-stimulating hormone
D) testicular biopsy
E) semen analysis

5. A 44-year-old man was referred for investigation of cortisol excess. He had poorly controlled hypertension, and a long history of type 2 diabetes mellitus with retinopathy and peripheral neuropathy. His medication comprised aspirin, ramipril, atenolol, carbamazepine, metformin and simvastatin.
Initial investigations:
serum cortisol (09.00 h)350 nmol/L (200-700)
serum cortisol (22.00 h)48 nmol/L (50-250)
overnight dexamethasone suppression test (after 1 mg dexamethasone):
serum cortisol93 nmol/L (<50)
24-h urinary free cortisol (day 1)225 nmol (55-250)
24-h urinary free cortisol (day 2)200 nmol (55-250)
24-h urinary free cortisol (day 3)185 nmol (55-250)
What is the most appropriate next step in management?

A) MR scan of pituitary
B) dexamethasone-suppressed corticotrophin-releasing hormone test
C) reassure and discharge
D) CT scan of adrenal glands
E) high-dose 48-h dexamethasone suppression test

Solutions: