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

1. A 16-year-old Caucasian girl presented with a 4-year history of facial hair growth, acne and secondary amenorrhoea.
On examination, her body mass index was 20 kg/m2 (18-25). Her gums and palmar creases were pigmented. Facial hair was evident on her upper lip and chin, and terminal hair was evident on her chest and abdomen. Her Ferriman-Gallwey score was 25. She had acne affecting her face and back.
Investigations:
serum dehydroepiandrosterone sulphate15 umol/L (3-12)
serum androstenedione12.2 nmol/L (0.6-8.8)
serum 17-hydroxyprogesterone120 nmol/L (1-10)
serum testosterone6.0 nmol/L (0.5-3.0)
serum sex hormone binding globulin18 nmol/L (40-137)
What treatment is likely to be of most benefit?

A) fludrocortisone
B) cyproterone acetate
C) metformin
D) hydrocortisone
E) flutamide

2. An 18-year-old man presented with delayed puberty.
On examination, he had a high arched palate. His sense of smell was intact, and he had a
family history of pubertal delay. Kallman's syndrome was suspected.
Investigations:
serum testosterone0.3 nmol/L (9.0-35.0)
serum follicle-stimulating hormone1.0 U/L (1.0-7.0)
serum luteinising hormone1.0 U/L (1.0-10.0)
bone age15 years
What further clinical finding would most strongly support the diagnosis of Kallman's
syndrome?

A) testes 6 mL bilaterally
B) short stature
C) eunuchoid habitus
D) bimanual synkinesia (mirror movements)
E) night blindness

3. A 17-year-old girl with Turner's syndrome attended the clinic for review. She had been treated with growth hormone therapy for the previous 7 years, and had now reached her final adult height.
What is the most appropriate next step in management?

A) continue growth hormone until 25 years old then reassess
B) stop growth hormone therapy
C) assess her bone density by DXA scan and continue growth hormone if bone mineral density is less than mean for age
D) withdraw growth hormone therapy for 3 months and evaluate growth hormone secretion
E) start to reduce growth hormone therapy with a view to discontinuing in 2 years' time

4. A 46-year-old Afro-Caribbean man with sarcoidosis was found to have hypercalcaemia and was treated with prednisolone 20 mg/day. Within 3 weeks his serum calcium had fallen to within the reference range.
How do glucocorticoids reduce serum calcium in sarcoidosis?

A) reduces extrarenal 1-?-hydroxylase activity
B) direct calcium shift into cells
C) increase intravascular fluid volume
D) suppress parathyroid hormone secretion
E) promote urinary calcium excretion

5. A 45-year-old woman attended for annual follow-up for long-standing hypoparathyroidism (a complication of thyroid surgery 5 years previously). She was asymptomatic. She was taking alfacalcidol 1 microgram daily.
Examination was unremarkable.
Investigations:
serum creatinine105 umol/L (60-110)
serum corrected calcium2.45 mmol/L (2.20-2.60)
24-h urinary calcium9.8 mmol (2.5-7.5)
What is the most appropriate next step in management?

A) change alfacalcidol to calcitriol
B) recommend low-calcium diet
C) decrease alfacalcidol dosage
D) add bendroflumethiazide
E) change alfacalcidol to teriparatide

Solutions: