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

1. A 45-year-old woman was found to be hypertensive by her general practitioner. She was otherwise well and was not taking any medication. However, she regularly ate health food containing liquorice. There was no family history of significant illness.
On examination, her blood pressure was 170/110 mmHg.
Investigations:
serum sodium140 mmol/L (137-144)
serum potassium3.8 mmol/L (3.5-4.9)
serum creatinine70 umol/L (60-110)
plasma renin activity (after 30 min supine)0.5 pmol/mL/h (1.1-2.7)
plasma aldosterone (after 30 min supine)450 pmol/L (135-400)
During the investigations, her blood pressure was controlled with doxazosin. What is the most likely diagnosis?

A) primary hyperaldosteronism
B) apparent mineralocorticoid excess
C) Gitelman's syndrome
D) pseudohyperaldosteronism
E) renal artery stenosis

2. A 43-year-old man was in an ENT ward, having recently undergone removal of a carotid body tumour.
Five years previously, he had undergone a similar procedure in another hospital. He also recalled that his brother had undergone surgery for a similar condition, and that his father, who had since died, might also have had neck surgery.
The ENT surgeons were concerned that there might be an underlying genetic diagnosis.
What is the most likely diagnosis?

A) von Hippel-Lindau disease
B) neurofibromatosis type 1
C) multiple endocrine neoplasia type 2
D) succinate dehydrogenase D deficiency
E) succinate dehydrogenase A deficiency

3. A 37-year-old woman presented with a 2-year history of increasingly frequent flushing episodes. She described alternating loose bowel motions and constipation. She had also noted menstrual irregularity. She had no respiratory symptoms. She denied headache or chest pain, but complained of palpitations.
On examination, she appeared well. Her blood pressure was 128/82 mmHg.
Investigations:
serum thyroid-stimulating hormone0.8 mU/L (0.4-5.0)
What is the most appropriate next investigation?

A) plasma metanephrines
B) serum gonadotrophins
C) fasting plasma gut hormones
D) urinary metanephrines
E) urinary 5-hydroxyindoleacetic acid

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

5. 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) 72 h
B) 2 weeks
C) 6 weeks
D) 1 week
E) 8 weeks

Solutions: