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

1. A 67-year-old man underwent an isotope bone scan after being found to have a raised serum alkaline phosphatase (of bone origin). The blood test had been ordered because of mild lower back pain, which had now resolved. He was not taking any medication.
Examination was normal.
Investigations:
isotope bone scansee image

What is the most likely diagnosis?

A) Paget's disease
B) prostate cancer
C) multiple myeloma
D) osteomalacia
E) fibrous dysplasia

2. A 77-year-old woman presented with a 10-week history of facial hirsutism, scalp hair loss and deepening of the voice.
On examination, her body mass index was 32 kg/m2 (18-25). Her blood pressure was 164/94 mmHg. She had coarse terminal hairs on her upper lip and beard areas. Abdominal examination was normal, but she refused examination of her external genitalia.
Investigations:
serum sodium144 mmol/L (137-144) serum potassium3.6 mmol/L (3.5-4.9) serum urea7.7 mmol/L (2.5-7.0) serum creatinine122 umol/L (60-110) fasting plasma glucose6.4 mmol/L (3.0-6.0) serum testosterone17.2 nmol/L (0.5-3.0) serum luteinising hormone2.2 U/L (>30.0)
What is the most appropriate initial investigation?

A) plasma adrenocorticotropic hormone and serum cortisol
B) serum dehydroepiandrosterone sulphate
C) overnight dexamethasone suppression test (after 1 mg dexamethasone)
D) CT scan of abdomen and pelvis
E) serum oestradiol

3. A 49-year-old woman presented with a slowly enlarging lump in her neck.
On examination, there was a 3.5-cm firm nodule in the left lobe of the thyroid gland, with no associated lymphadenopathy.
Investigations:
serum thyroid-stimulating hormone<0.05 mU/L (0.4-5.0)
serum free T426.0 pmol/L (10.0-22.0)
serum free T38.6 pmol/L (3.0-7.0)
An ultrasound scan showed an enlarged thyroid gland, with small nodules throughout. There was a larger hypoechoic 3.3-cm nodule with increased intranodular vascularity in the lower pole of the left lobe, with no associated lymphadenopathy.
What is the most appropriate management?

A) isotope uptake scan
B) core biopsy of the thyroid nodule
C) partial thyroidectomy
D) radioactive iodine treatment
E) fine-needle aspiration of the nodule

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

5. A 20-year-old woman with Turner's syndrome had heard that there was a risk of ovarian cancer associated with Turner's syndrome. She asked to undergo a pre-emptive oophorectomy.
For what genotype is oophorectomy most likely to be recommended?

A) 45XO
B) 45X/47XXX
C) 45X/46Xxi (Xq)
D) 45X/46XY
E) 45X/46XX

Solutions: