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

1. An 18-year-old man presented with delayed puberty.
On examination, he had a high arched palate. His sense of smell was intact, and he had a
family history of pubertal delay. Kallman's syndrome was suspected.
Investigations:
serum testosterone0.3 nmol/L (9.0-35.0)
serum follicle-stimulating hormone1.0 U/L (1.0-7.0)
serum luteinising hormone1.0 U/L (1.0-10.0)
bone age15 years
What further clinical finding would most strongly support the diagnosis of Kallman's
syndrome?

A) testes 6 mL bilaterally
B) bimanual synkinesia (mirror movements)
C) short stature
D) eunuchoid habitus
E) night blindness

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

3. A 56-year-old man presented with a 6-month history of erectile dysfunction. He had noticed a gradual reduction in his frequency of shaving from daily to twice a week. His libido had diminished and he felt that he was not as strong as he once was. He also described general aches and pains. He was a farm worker and had drunk a bottle of vodka daily for several years, but had stopped drinking 2 years previously. He was a non-smoker.
Investigations:
serum urea6.2 mmol/L (2.5-7.0)
serum creatinine89 umol/L (60-110)
serum albumin40 g/L (37-49)
serum total bilirubin17 umol/L (1-22) serum alanine aminotransferase48 U/L (5-35) serum aspartate aminotransferase37 U/L (1-31) haemoglobin A1c55 mmol/mol (20-42)
serum cortisol (09.00 h)389 nmol/L (200-700) serum testosterone0.7 nmol/L (9.0-35.0) plasma follicle-stimulating hormone2.1 U/L (1.0-7.0) plasma luteinising hormone2.4 U/L (1.0-10.0) serum prolactin458 mU/L (<360) serum thyroid-stimulating hormone3.4 mU/L (0.4-5.0)
MR scan of pituitarysee image

What is the most likely explanation of his symptoms?

A) age-related hypogonadism
B) pituitary adenoma
C) haemochromatosis
D) hyperprolactinaemia
E) cirrhosis of liver

4. A 48-year-old man was investigated for a 6-month history of tiredness. There was no other medical history and he was taking no medication.
Investigations:
estimated glomerular filtration rate (MDRD)36 mL/min/1.73 m2 (>60) serum corrected calcium2.25 mmol/L (2.20-2.60) serum phosphate1.1 mmol/L (0.8-1.4)
plasma parathyroid hormone8.1 pmol/L (0.9-5.4) serum 25-OH-cholecalciferol48 nmol/L (45-90)
What is the most important next step in management?

A) refer for nephrological advice
B) prescribe calcium and vitamin D supplements
C) refer for parathyroidectomy
D) reassure and repeat in 3 months
E) reassure and discharge from clinic

5. A 34-year-old woman with Addison's disease reported four adrenal crises over the preceding 6 months, requiring hospital admission and intravenous administration of hydrocortisone. At outpatient follow-up, she was taking hydrocortisone 15 mg in the morning and 10 mg at midday, and fludrocortisone 50 micrograms daily.
What is the most important next step in management to prevent further crises?

A) measure post-dose 09.00 h cortisol
B) change to sustained-release hydrocortisone
C) measure plasma renin
D) measure plasma adrenocorticotropic hormone
E) increase dosage of hydrocortisone

Solutions: