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

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

2. A 17-year-old girl presented with primary amenorrhoea. She had grown and developed normally. There was no history of galactorrhoea or hirsutism.
On examination, her height was 1.69 m, her weight was 68.3 kg, and her body mass index was 23.9 kg/m2 (18-25). She had stage 5 breast development and stage 5 pubic hair. Her visual fields were full to confrontation.
Investigations:
serum cortisol (09.00 h)416 nmol/L (200-700) serum oestradiol51 pmol/L (200-400)
serum follicle-stimulating hormone0.8 U/L (2.5-10.0) serum luteinising hormone1.2 U/L (2.5-10.0) serum thyroid-stimulating hormone1.2 mU/L (0.4-5.0) serum free T415.6 pmol/L (10.0-22.0)
What is the most appropriate next investigation?

A) short tetracosactide (Synacthen@) test
B) luteinising hormone-releasing hormone test
C) serum prolactin
D) serum insulin-like growth factor 1
E) karyotyping

3. An 85-year-old woman was referred with a lump in her neck. She had no symptoms of thyroid disease.
On examination, she had a 2 ? 3-cm firm mass at the lower pole in the right thyroid lobe. Her resting pulse was 90 beats per minute and regular.
Investigations:
serum thyroid-stimulating hormone3.5 mU/L (0.4-5.0)
serum free T415.0 pmol/L (10.0-22.0)
serum free T36.2 pmol/L (3.0-7.0)
anti-thyroid peroxidase antibodies28 IU/mL (<50) ultrasound scan of thyroidmixed cystic/solid mass with scattered microcalcifications
fine-needle aspiration biopsyThy 3a
What is the most appropriate next step in her management?

A) CT scan of neck
B) PET scan of thyroid
C) repeat fine-needle aspiration
D) ablative radioiodine treatment
E) subtotal thyroidectomy

4. A 73-year-old man had been attending the diabetes clinic for 6 weeks with an ulcer on his right second metatarsal head. He had been receiving regular podiatry and offloading.
What new feature in the appearance of his foot is most likely to suggest the need to start antibiotics?

A) skin redness around ulcer
B) tracking sinus
C) increase in ulcer size
D) pain around ulcer
E) ulcer probing to bone

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

Solutions: