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

1. A 70-year-old man was admitted after the gradual development of confusion. He had no
significant medical history.
Examination was otherwise normal.
Investigations:
serum sodium110 mmol/L (137-144)
serum potassium3.8 mmol/L (3.5-4.9)
serum creatinine50 umol/L (60-110)
He was treated with several litres of sodium chloride 0.9% over the subsequent few days, resulting in a rapid restoration of serum sodium to the normal range. This coincided with the development of limb weakness and spasticity that became permanent.
The movement of what substance(s) between the intracellular fluid compartment (ICF) and extracellular fluid compartment (ECF) explains the changes in this patient?

A) sodium from ECF to ICF
B) water from ICF to ECF
C) water from ECF to ICF
D) sodium and water from ECF to ICF
E) sodium from ICF to ECF

2. A 49-year-old woman presented with a mass in her neck that was causing no specific symptoms.
Examination revealed a solitary nodule in the right thyroid lobe, with no associated lymphadenopathy. Thyroid function was normal. No other abnormality was noted. There was no evidence of lymphadenopathy in the neck.
Investigations:
ultrasound scan of necksolid hypoechoic nodule 1.8 ? 1.2 ? 1 cm
in right thyroid lobe;
cyst 0.6 ? 0.3 ? 0.2 cm in left thyroid lobe
cytology (fine-needle aspirationscanty colloid with abundant
from nodule in right lobe)thyroid follicular cells (Thy3f)
What is the most appropriate next step in management?

A) repeat cytology for confirmation
B) reassure that the nodule is not malignant and discharge
C) serum thyroglobulin
D) total thyroidectomy for histological diagnosis
E) thyroid lobectomy for histological diagnosis

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

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

5. A 55-year-old woman presented complaining of difficulty losing weight.
On examination, her blood pressure was 170/105 mmHg and urinalysis showed protein 1+.
An ultrasound scan of abdomen revealed a 4.5-cm solid lesion in the right adrenal gland. She was treated with ramipril and further endocrine evaluation was performed.
Investigations:
serum potassium3.6 mmol/L (3.5-4.9)
serum creatinine135 umol/L (60-110)
plasma renin activity:
(after 30 min supine)3.9 pmol/mL/h (1.1-2.7)
(after 30 min upright)6.8 pmol/mL/h (3.0-4.3)
plasma aldosterone:
(after 30 min supine)150 pmol/L (135-400)
(after 4 h upright)350 pmol/L (330-830)
serum cortisol (09.00 h)650 nmol/L (200-700)
serum cortisol (22.00 h)225 nmol/L (50-250)
24-h urinary free cortisol230 nmol (55-250)
24-h urinary dopamine3200 nmol (<3100)
24-h urinary adrenaline120 nmol (<144)
24-h urinary noradrenaline450 nmol (<570)
What is the most appropriate initial management of the adrenal lesion?

A) surgical excision
B) medical observation with annual ultrasonography
C) angiotensin-2 receptor blockade
D) ?-adrenoceptor blockade
E) mineralocorticoid receptor blockade

Solutions: