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MRCPUK Endocrinology and Diabetes (Specialty Certificate Examination) Sample Questions:
1. A 35-year-old woman was referred with a left lower thyroid lesion. She was asymptomatic.
Examination confirmed the presence of a 2 ? 3-cm, firm, mobile, non-tender mass.
Investigations:
ultrasound-guided fine-needle aspiration biopsyThy 5
How is Thy 5 defined?
A) follicular lesions
B) non-neoplastic (consistent with nodular goitre or thyroiditis)
C) non-diagnostic or inadequate
D) abnormal, suspicious (but not diagnostic of) malignancy
E) abnormal, diagnostic of malignancy
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) eunuchoid habitus
B) short stature
C) night blindness
D) testes 6 mL bilaterally
E) bimanual synkinesia (mirror movements)
3. A 49-year-old woman presented with a mass in her neck that was causing no specific symptoms.
Examination revealed a solitary nodule in the right thyroid lobe, with no associated lymphadenopathy. Thyroid function was normal. No other abnormality was noted. There was no evidence of lymphadenopathy in the neck.
Investigations:
ultrasound scan of necksolid hypoechoic nodule 1.8 ? 1.2 ? 1 cm
in right thyroid lobe;
cyst 0.6 ? 0.3 ? 0.2 cm in left thyroid lobe
cytology (fine-needle aspirationscanty colloid with abundant
from nodule in right lobe)thyroid follicular cells (Thy3f)
What is the most appropriate next step in management?
A) total thyroidectomy for histological diagnosis
B) reassure that the nodule is not malignant and discharge
C) thyroid lobectomy for histological diagnosis
D) repeat cytology for confirmation
E) serum thyroglobulin
4. 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) loss of ?2-adrenoceptor-mediated vasodilatation
B) propranolol acting as an agonist at ?1-adrenoceptors
C) inhibition of catechol-O-methyltransferase by propranolol leading to an increase in circulating noradrenaline
D) ?1-adrenoceptor blockade leading to acute left ventricular dysfunction
E) inadequate ?-adrenoceptor blockade because of the short half-life of the drug
5. A 67-year-old man underwent an isotope bone scan after being found to have a raised serum alkaline phosphatase (of bone origin). The blood test had been ordered because of mild lower back pain, which had now resolved. He was not taking any medication.
Examination was normal.
Investigations:
isotope bone scansee image
What is the most likely diagnosis?
A) multiple myeloma
B) osteomalacia
C) fibrous dysplasia
D) Paget's disease
E) prostate cancer
Solutions:
| Question # 1 Answer: E | Question # 2 Answer: E | Question # 3 Answer: C | Question # 4 Answer: A | Question # 5 Answer: D |
