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

1. A 55-year-old male-to-female transsexual was reviewed in clinic. She lived as a woman but had not undergone gender reassignment surgery. She was treated with cyproterone acetate 50 mg twice daily and estradiol 2 mg twice daily.
What are the most important tests for monitoring safe replacement?

A) lipid profile and liver function tests
B) lipid profile and serum prostate-specific antigen
C) liver function tests and full blood count
D) liver function tests and serum prostate-specific antigen
E) serum prostate-specific antigen and full blood count

2. A 37-year-old man, who had previously undergone female-to-male gender reassignment surgery, attended the endocrine clinic for annual review. He had no complaints and was happy with the results of his treatment. His medication consisted of testosterone undecanoate 1 g intramuscularly every 3 months.
What variable is it most important to monitor?

A) fasting plasma glucose
B) serum testosterone
C) haematocrit
D) serum luteinising hormone
E) serum prostate-specific antigen

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

4. A 32-year-old woman presented at 34 weeks of pregnancy, after an episode of vaginal bleeding. Gestational diabetes had been diagnosed at 28 weeks and insulin was started at 29 weeks. Her pre-pregnancy body mass index was 32 kg/m2 (18-25) and there was no family history of diabetes. She was treated with betamethasone 12 mg over 2 days. She was taking 60 units of insulin subcutaneously daily (40 units prandial in three divided doses, and 20 units intermediate-acting insulin), which had been unchanged for 3 weeks.
On examination, she was apyrexial, her pulse was 96 beats per minute and her blood pressure was 124/74 mmHg. Urinalysis showed blood 1+, protein 1+, glucose 2+, ketones 3+.
Investigations:
serum sodium134 mmol/L (137-144)
serum potassium3.8 mmol/L (3.5-4.9)
serum chloride105 mmol/L (95-107) serum urea5.0 mmol/L (2.5-7.0) serum creatinine90 umol/L (60-110) random plasma glucose7.2 mmol/L
What is the most appropriate next step in management?

A) continue to monitor blood glucose in hospital
B) discharge and monitor blood glucose at home
C) increase subcutaneous insulin doses by 2-4 units
D) start intravenous insulin
E) measure venous bicarbonate

5. A 27-year-old woman presented with oligomenorrhoea and hirsutism, and a 2-year history of infertility. Her body mass index was 26 kg/m2 (18-25). Her partner had a recent normal sperm count and motility test.
Investigations:
serum androstenedione17.0 nmol/L (0.6-8.8)
serum 17-hydroxyprogesterone2 nmol/L (1-10)
serum testosterone2.8 nmol/L (0.5-3.0)
serum sex hormone binding globulin18 nmol/L (40-137)
serum follicle-stimulating hormone2.3 U/L (2.5-10.0)
serum luteinising hormone8.3 U/L (2.5-10.0)
serum prolactin152 mU/L (<360)
A diagnosis of polycystic ovary syndrome was made.
What is the most effective next step to help her conceive?

A) diet and exercise
B) orlistat
C) clomifene
D) in vitro fertilisation
E) metformin

Solutions: