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

2. A 17-year-old girl was referred to the outpatient clinic with irritability, weight loss and difficulty sleeping. At the age of 4, she had presented with rapid growth, breast development and vaginal bleeding. The results of a gonadotropin-releasing hormone (GnRH) stimulation test performed at that time are given below.
serum oestradiolplasma FSHplasma LH
(200-400 pmol/L)(2.5-10.0 U/L)(2.5-10.0 U/L)
0 min365<0.7<0.5
30 min-<0.7<0.5
60 min-<0.7<0.5
She had been treated with GnRH analogue until the age of 11 and puberty had then progressed normally.
On examination, she was found to be tremulous, tachycardic and hyper-reflexic. Several large, irregular cafe-au-lait spots were found.
Investigations:
serum thyroid-stimulating hormone<0.05 mU/L (0.4-5.0)
serum free T436.0 pmol/L (10.0-22.0)
What is the most likely diagnosis?

A) neurofibromatosis type 1
B) multiple endocrine neoplasia type 2
C) Cowden's syndrome
D) McCune-Albright syndrome
E) Carney's complex

3. A 24-year-old man was referred for investigation of infertility. He had been having unprotected intercourse with his partner for 18 months, but the couple had failed to conceive. He had been treated for Hodgkin's lymphoma at the age of 17.
What is the most appropriate investigation?

A) testicular biopsy
B) serum inhibin
C) serum testosterone
D) serum follicle-stimulating hormone
E) semen analysis

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

5. A 16-year-old boy was referred with concern about delayed puberty. His stature had been short as a child. He reported an increase in height at the age of 13, and had begun to develop pubic hair at the age of 14. He reported no further growth or development in the past year. His father recalled going through puberty at the age of 13.
On examination, his height was 1.60 m (between 0.4th and 2nd centile), weight was 56.4 kg (between 9th and 25th centile), genital development was Tanner stage 2 and testicular volume was 8 mL bilaterally. Pubic hair was Tanner stage 2, with no evidence of androgenic axillary hair. Bone age at the left wrist was 13.5 years.
Investigations:
serum testosterone2.9 nmol/L (9.0-35.0)
Which feature in his clinical presentation most strongly suggests a diagnosis other than constitutional delay?

A) discordance between the height centile and the weight centile
B) absence of axillary hair in the presence of pubic hair
C) 2.5-year delay in bone age
D) failure to progress through puberty
E) being below the 2nd centile for height

Solutions: