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

1. A 25-year-old woman presented with a solitary nodule in the right lobe of her thyroid gland.
Investigations:
serum thyroid-stimulating hormone0.45 mU/L (0.4-5.0)
serum free T420.7 pmol/L (10.0-22.0)
The presence of which feature would most increase the likelihood of malignancy?

A) high titre of thyroid peroxidase antibodies
B) size of nodule >1.0 cm in maximum diameter
C) microcalcification seen within the nodule on ultrasound scan
D) increased peripheral vascularity of nodule on Doppler ultrasound
E) elevated serum thyroglobulin concentration

2. A 76-year-old man with a 17-year history of type 2 diabetes mellitus attended for his annual review. Comparison of his retinal screening report with the previous year's report showed that his visual acuity was unchanged at 6/9 in both eyes. The previous year's right eye retinal image had been reported as 'pre-proliferative retinopathy', whereas this year's was reported as 'pre-proliferative retinopathy with maculopathy'.
What is the most appropriate next step?

A) routine referral to an ophthalmologist
B) routine re-screen in 6 months
C) routine re-screen in 12 months
D) urgent referral to an ophthalmologist within 2 weeks
E) urgent re-screen within 2 weeks

3. A 24-year-old woman was referred with an 18-month history of worsening hirsutism, primarily on her face, but also new hair growth on her chest. She was shaving weekly. She had always been overweight, but had recently gained 5 kg and her body mass index was 31 kg/m2 (18-25). Her periods were regular.
What is the most relevant next investigation?

A) serum 17-hydroxyprogesterone
B) overnight dexamethasone suppression test (after 1 mg dexamethasone)
C) serum testosterone
D) serum dehydroepiandrosterone
E) plasma thyroid-stimulating hormone

4. A 28-year-old man presented to his optician with a 6-month history of gradually deteriorating vision. He was found to have a visual field defect and was referred urgently to an ophthalmologist who confirmed the finding, and arranged the following investigations.
Investigations (at 09.00 h):
serum cortisol300 nmol/L (200-700) serum testosterone6.5 nmol/L (9.0-35.0) plasma follicle-stimulating hormone1.2 U/L (1.0-7.0) plasma luteinising hormone1.3 U/L (1.0-10.0) serum thyroid-stimulating hormone2.4 mU/L (0.4-5.0) serum free T411.1 pmol/L (10.0-22.0)
What is the most important next investigation?

A) insulin stress test
B) prolactin
C) adrenocorticotropic hormone
D) short tetracosactide (Synacthen@) test
E) random growth hormone

5. A 39-year-old woman with Graves' disease was considered suitable for treatment with radioiodine. She was keen that her thyrotoxicosis should not recur. The plan was to request a 600 MBq dose.
What is the probability of resolution of thyrotoxicosis with this dose?

A) >95%
B) 60%
C) 20%
D) 80%
E) 40%

Solutions: