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

1. A 26-year-old woman presented with recurrent Graves' disease. After discussing the treatment options, she chose radioiodine.
What dose of radioiodine is most appropriate in uncomplicated Graves' disease?

A) 400-600 MBq
B) 1000-1200 MBq
C) 1400-1600 MBq
D) 100-200 MBq
E) 700-900 MBq

2. A 23-year-old barmaid presented with headache, sweating and collapse. She had a past medical history of tension headache and unexplained abdominal pain. Her regular medication included amitriptyline 25 mg at night and paracetamol 1 g as required. She was a smoker and regularly drank alcohol.
On examination, her pulse was 120 beats per minute and her blood pressure was 210/128 mmHg.
Investigations:
24-h urinary metanephrine5.4 umol (<2)
24-h urinary normetanephrine15.2 umol (<3) What substance is most likely to cause assay interference in the measurement of urinary metanephrines?

A) alcohol
B) paracetamol
C) caffeine
D) amitriptyline
E) nicotine

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

4. A 36-year-old woman was seen in the clinic with a recurrence of hyperthyroidism after a 2year remission. She had been treated with carbimazole for 18 months following her original presentation. She was moderately symptomatic and was keen to be treated in the same way again. She was planning a pregnancy.
Investigations: serum prolactin240 mU/L (<360) serum thyroid-stimulating hormone<0.1 mU/L (0.4-5.0) serum free T428.0 pmol/L (10.0-22.0)
anti-thyroid-stimulating hormone receptor antibodies44 U/L (<7)
What is the most appropriate next step in management?

A) referral for thyroidectomy
B) carbimazole
C) propylthiouracil
D) radioiodine treatment
E) block-and-replace treatment with carbimazole and levothyroxine

5. A 28-year-old woman presented to the emergency department with a 3-day history of abdominal pain. Her past medical history included intermenstrual bleeding, and she was undergoing 6-monthly renal ultrasound surveillance for a cystic lesion.
Investigations:
serum creatinine84 umol/L (60-110)
serum corrected calcium3.20 mmol/L (2.20-2.60)
serum phosphate0.7 mmol/L (0.8-1.4)
plasma parathyroid hormone19.5 pmol/L (0.9-5.4)
What is the most likely condition underlying the clinical presentation?

A) von Hippel-Lindau syndrome
B) multiple endocrine neoplasia type 1
C) Cowden's syndrome
D) multiple endocrine neoplasia type 2B
E) hyperparathyroidism-jaw tumour syndrome

Solutions: