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

1. Five patients were referred to a rapid access thyroid clinic. Only four slots were available in the following month.
Which patient can safely be deferred to a later clinic?

A) 16-year-old boy with a thyroid nodule
B) 45-year-old woman with a rapidly enlarging painless goitre
C) 39-year-old woman with a slowly growing thyroid lump and a palpable cervical lymph node
D) 67-year-old man with a goitre and hoarseness
E) 44-year-old woman with a history of sudden-onset pain in a thyroid lump

2. A 72-year-old woman presented with a painless swelling in the front of the neck, which she had first noticed 2-3 months previously. She was otherwise well, with no symptoms of mass effect in her neck, and was not taking any medication.
On examination, her thyroid gland was moderately enlarged, and felt uniformly nodular. There was no associated lymphadenopathy. Her pulse was 78 beats per minute and regular, and there were no signs of thyrotoxicosis.
Investigations:
serum thyroid-stimulating hormone<0.01 mU/L (0.4-5.0)
serum free T424.8 pmol/L (10.0-22.0)
serum free T310.3 pmol/L (3.0-7.0)
technetium-99m scan of thyroid (20-min uptake)patchy uptake in both thyroid lobes
What is the most appropriate management?

A) total thyroidectomy
B) repeat thyroid function tests after 6 months
C) partial thyroidectomy
D) carbimazole plus levothyroxine
E) radioiodine

3. A 32-year-old woman presented at 34 weeks of pregnancy, after an episode of vaginal bleeding. Gestational diabetes had been diagnosed at 28 weeks and insulin was started at 29 weeks. Her pre-pregnancy body mass index was 32 kg/m2 (18-25) and there was no family history of diabetes. She was treated with betamethasone 12 mg over 2 days. She was taking 60 units of insulin subcutaneously daily (40 units prandial in three divided doses, and 20 units intermediate-acting insulin), which had been unchanged for 3 weeks.
On examination, she was apyrexial, her pulse was 96 beats per minute and her blood pressure was 124/74 mmHg. Urinalysis showed blood 1+, protein 1+, glucose 2+, ketones 3+.
Investigations:
serum sodium134 mmol/L (137-144)
serum potassium3.8 mmol/L (3.5-4.9)
serum chloride105 mmol/L (95-107) serum urea5.0 mmol/L (2.5-7.0) serum creatinine90 umol/L (60-110) random plasma glucose7.2 mmol/L
What is the most appropriate next step in management?

A) increase subcutaneous insulin doses by 2-4 units
B) discharge and monitor blood glucose at home
C) start intravenous insulin
D) continue to monitor blood glucose in hospital
E) measure venous bicarbonate

4. Carbimazole is routinely used in the management of thyroid disease.
What does carbimazole inhibit?

A) deiodinase type 1
B) presentation of thyroid antigens to autoreactive T cells
C) thyroid peroxidase
D) sodium/iodide symporter
E) thyroglobulin synthesis

5. A 19-year-old man presented with late development of his pubic and axillary hair. He was otherwise well and was not taking any medication. His serum testosterone concentration had been normal on two previous occasions.
On examination, he now had post-pubertal secondary sexual characteristics. He had 15-20 mL testes.
Investigations:
serum testosterone27.0 nmol/L (9.0-35.0)
serum sex hormone binding globulin28 nmol/L (10-62)
serum follicle-stimulating hormone2.0 U/L (1.0-7.0)
serum luteinising hormone2.9 U/L (1.0-10.0)
What is the chief product of the Sertoli cell?

A) anti-Muellerian hormone
B) oestrogen
C) kisspeptin
D) serum sex hormone binding globulin
E) testosterone

Solutions: