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

1. A 26-year-old woman presented with recurrent Graves' disease. After discussing the treatment options, she chose radioiodine.
What dose of radioiodine is most appropriate in uncomplicated Graves' disease?

A) 700-900 MBq
B) 100-200 MBq
C) 400-600 MBq
D) 1000-1200 MBq
E) 1400-1600 MBq

2. A 32-year-old man presented to the fertility clinic with his partner. The couple had been together for 4 years and had been trying to conceive for the past 3 years. His partner had children from a previous marriage.
On examination, he was healthy, thin and tall but had bilateral gynaecomastia. His testes felt firm and testicular volumes were 5-6 mL. He had normal pubic and axillary hair.
Investigations:
serum testosterone10.0 nmol/L (9.0-35.0) plasma follicle-stimulating hormone45.0 U/L (1.0-7.0) plasma luteinising hormone32.0 U/L (1.0-10.0)
chromosomal studiesmosaic pattern of 47 XXY/46 XY
semen analysisazoospermia testicular biopsyno viable spermatozoa
What intervention is most likely to lead to conception?

A) testosterone
B) pulsatile gonadotropin-releasing hormone
C) artificial insemination by donor
D) intracytoplasmic sperm injection
E) human chorionic gonadotropin

3. A 23-year-old man presented with a history of discomfort with his gender for as long as he could remember. He believed he was transsexual.
What element of further history would most strongly support his self-diagnosis?

A) the presence of gender somatic delusions that emerge and strengthen with time
B) sexual excitement by cross-dressing
C) a long-standing intense wish to make his body conform to that of the preferred gender
D) conscious and absolute rejection of his sexual orientation as socially unacceptable
E) seeking medical rationalisation for sexuality through genital surgery

4. 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) failure to progress through puberty
C) 2.5-year delay in bone age
D) being below the 2nd centile for height
E) absence of axillary hair in the presence of pubic hair

5. A 70-year-old man was admitted after the gradual development of confusion. He had no
significant medical history.
Examination was otherwise normal.
Investigations:
serum sodium110 mmol/L (137-144)
serum potassium3.8 mmol/L (3.5-4.9)
serum creatinine50 umol/L (60-110)
He was treated with several litres of sodium chloride 0.9% over the subsequent few days, resulting in a rapid restoration of serum sodium to the normal range. This coincided with the development of limb weakness and spasticity that became permanent.
The movement of what substance(s) between the intracellular fluid compartment (ICF) and extracellular fluid compartment (ECF) explains the changes in this patient?

A) sodium from ICF to ECF
B) sodium and water from ECF to ICF
C) sodium from ECF to ICF
D) water from ICF to ECF
E) water from ECF to ICF

Solutions: