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

1. A 25-year-old woman with type 1 diabetes mellitus was admitted to hospital with a 12-hour
history of nausea and lethargy.
On examination, her temperature was 37.5C, she was dehydrated and her Glasgow coma
score was 14. Urinalysis showed glucose 2+, ketones 3+, protein negative.
Investigations:
white cell count12.0 ? 109/L (4.0-11.0)
neutrophil count8.0 ? 109/L (1.5-7.0)
random plasma glucose22.0 mmol/L
arterial blood gases, breathing air:
pH7.20 (7.35-7.45)
serum C-reactive protein12 mg/L (<10)
She was treated with intravenous sodium chloride 0.9% and fixed-rate intravenous insulin
infusion, and initially improved. Twelve hours into her admission, she complained of a
headache.
On examination, her temperature was 37.3C and her Glasgow coma score was 15. Her
pulse was 85 beats per minute and her blood pressure was 110/70 mmHg. There was no
neck stiffness, papilloedema or focal neurological signs.
What is the most likely cause for her headache?

A) sagittal sinus thrombosis
B) bacterial meningitis
C) cerebral oedema
D) viral encephalitis
E) tension headache

2. A 47-year-old man presented with a 2-month history of polyuria and polydipsia. He awoke six times most nights to pass copious volumes of urine despite not drinking any fluid for 4 hours before going to bed.
Investigations:
MR scan of pituitary fossasee image
A water deprivation test confirmed the diagnosis of cranial diabetes insipidus.

What is the most likely underlying diagnosis?

A) chordoma
B) craniopharyngioma
C) microadenoma
D) meningioma
E) Langerhans' histiocytosis

3. A 41-year-old man presented to his general practitioner with symptoms of palpitations, sweating and anxiety. His blood pressure was 160/102 mmHg. He was advised to take propranolol 40 mg twice daily but was admitted to hospital later that week with an episode of pulmonary oedema.
On examination at the time of admission, he was noted to be pale and sweating and he had a blood pressure of 210/124 mmHg. A phaeochromocytoma was suspected.
What is the most likely cause of the cardiovascular deterioration following administration of propranolol?

A) inhibition of catechol-O-methyltransferase by propranolol leading to an increase in circulating noradrenaline
B) ?1-adrenoceptor blockade leading to acute left ventricular dysfunction
C) propranolol acting as an agonist at ?1-adrenoceptors
D) loss of ?2-adrenoceptor-mediated vasodilatation
E) inadequate ?-adrenoceptor blockade because of the short half-life of the drug

4. A 34-year-old woman with Addison's disease reported four adrenal crises over the preceding 6 months, requiring hospital admission and intravenous administration of hydrocortisone. At outpatient follow-up, she was taking hydrocortisone 15 mg in the morning and 10 mg at midday, and fludrocortisone 50 micrograms daily.
What is the most important next step in management to prevent further crises?

A) measure plasma renin
B) measure plasma adrenocorticotropic hormone
C) change to sustained-release hydrocortisone
D) measure post-dose 09.00 h cortisol
E) increase dosage of hydrocortisone

5. A 20-year-old man presented with a 6-month history of lethargy and weakness. His brother had been found to have adrenal failure at the age of 18. He had two sisters who were well and there was no other family history of endocrine autoimmune disease.
On examination, his blood pressure was 100/60 mmHg.
Investigations:
serum sodium136 mmol/L (137-144)
serum potassium4.8 mmol/L (3.5-4.9)
short tetracosactide (Synacthen@) test (250 micrograms):
baseline serum cortisol100 nmol/L
serum cortisol (30 min after tetracosactide)250 nmol/L (>550)
anti-adrenal antibodiesnegative
What is the most important diagnosis to consider?

A) tuberculosis
B) adrenoleucodystrophy
C) familial glucocorticoid resistance
D) autoimmune hypoadrenalism
E) isolated adrenocorticotropic hormone deficiency

Solutions: