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

1. A 17-year-old boy was concerned about his height. He had been treated for Crohn's disease since the age of 13 with a combination of topical and systemic corticosteroids and azathioprine. He was currently taking mercaptopurinE.
On examination, his height was on the 25th centile.
Investigations:
X-ray of right kneesee image

What is the most appropriate next step in management?

A) advise him that he will continue to grow for 12 months
B) investigate for growth hormone deficiency
C) refer for leg lengthening surgery
D) treat with growth hormone
E) advise him that growth is complete

2. A 78-year-old man presented with confusion, lethargy and thirst. He had hypertension treated with lisinopril 20 mg daily.
On examination, he was dehydrated. His pulse was 110 beats per minute and his blood pressure was 84/40 mmHg. Urinalysis showed ketones 1+.
Investigations:
serum sodium155 mmol/L (137-144) serum potassium5.2 mmol/L (3.5-4.9) serum bicarbonate17 mmol/L (20-28) serum urea40.0 mmol/L (2.5-7.0)
serum creatinine358 umol/L (60-110) random plasma glucose78.0 mmol/L He was treated with sodium chloride 0.9%. After 8 hours' treatment, his urine output was
10 mL/h and his blood pressure was 121/50 mmHg. Investigations (after 8 hours' treatment): serum sodium151 mmol/L (137-144)
serum potassium4.9 mmol/L (3.5-4.9) serum bicarbonate18 mmol/L (20-28) serum urea39.0 mmol/L (2.5-7.0) serum creatinine347 umol/L (60-110)
random plasma glucose48.0 mmol/L
What is the most appropriate next step in management?

A) compound lactate solution (Hartmann's solution)
B) sodium chloride 0.45%
C) sodium chloride 0.18% and glucose 5%
D) sodium chloride 0.18% and glucose 4%
E) sodium chloride 0.9%

3. A 52-year-old man had been found to have type 1 diabetes mellitus at the age of 25. He had developed retinopathy at the age of 31 and a painless foot ulcer at the age of 40. His renal function had subsequently deteriorated.
On examination, urinalysis showed protein 1+, glucose 2+.
What is the most likely diagnosis?

A) focal segmental glomerulosclerosis
B) minimal change glomerulonephritis
C) tubulointerstitial nephritis
D) nodular glomerulosclerosis
E) membranoproliferative glomerulonephritis

4. A 55-year-old woman presented with a 3-week history of nausea and vomiting. Her only medical complaints were frequent dyspepsia, for which she was taking indigestion tablets, and asthma for which she was taking a salbutamol inhaler as required.
On examination, there was no evidence of lymphadenopathy, her chest was clear on auscultation and abdominal examination was normal.
Investigations (before and after taking omeprazole for 3 weeks):
beforeafternormal erythrocyte sedimentation rate (mm/1st h)44<30 serum creatinine (umol/L)17011060-110 serum corrected calcium (mmol/L)2.852.402.20-2.60
serum phosphate (mmol/L)1.90.8-1.4
serum angiotensin-converting enzyme (U/L)8525-82
plasma parathyroid hormone (pmol/L)0.44.40.9-5.4
What is the most likely cause of the hypercalcaemia?

A) multiple myeloma
B) primary hyperparathyroidism
C) milk-alkali syndrome
D) sarcoidosis
E) parathyroid hormone-related peptide-secreting malignancy

5. A 17-year-old Caucasian girl presented with primary amenorrhea.
On examination, her body mass index was 21 kg/m2 (18-25). Her body habitus was normal and she had appropriate breast development. There was no hirsutism or acne.
Investigations:
serum oestradiol<180 pmol/L (200-400) serum testosterone31.7 nmol/L (0.5-3.0) serum follicle-stimulating hormone4.0 U/L (2.5-10.0) serum luteinising hormone6.0 U/L (2.5-10.0)
What is the most likely diagnosis?

A) ovarian hyperthecosis
B) adrenocortical carcinoma
C) complete androgen insensitivity syndrome
D) polycystic ovary syndrome
E) androgen-secreting ovarian tumour

Solutions: