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Exam Name: Endocrinology and Diabetes (Specialty Certificate Examination)

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NO.1 A 75-year-old woman presented with a 4-week history of lethargy. Her medical history was
unremarkable and she took no medication.
On examination, her blood pressure was 140/70 mmHg lying. She was euvolaemic.
Investigations:
serum sodium120 mmol/L (137-144)
serum potassium3.8 mmol/L (3.5-4.9)
serum urea3.0 mmol/L (2.5-7.0)
serum creatinine75 umol/L (60-110)
short tetracosactide (Synacthen@) test (250 micrograms):
baseline serum cortisol450 nmol/L (200-700)
serum cortisol (30 min after tetracosactide)600 nmol/L (>550)
serum thyroid-stimulating hormone2.5 mU/L (0.4-5.0)
serum free T416.9 pmol/L (10.0-22.0)
urinary sodium70 mmol/L
What is the most appropriate initial management?
A. fluid restriction
B. tolvaptan
C. intravenous sodium chloride 0.9%
D. demeclocycline
E. hydrocortisone
Answer: A
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NO.2 A 17-year-old boy, with short stature, obesity and neurobehavioural problems, was referred
because of cold intolerance.
On examination, he and his mother had similar body habitus and short fingers (brachydactyly).
Investigations (before attending clinic):
serum sodium143 mmol/L (137-144) serum potassium4.4 mmol/L (3.5-4.9) serum creatinine93
umol/L (60-110) serum corrected calcium2.02 mmol/L (2.20-2.60) serum phosphate1.7 mmol/L (0.8-
1.4)
serum thyroid-stimulating hormone16.0 mU/L (0.4-5.0) serum free T410.0 pmol/L (10.0-22.0) plasma
parathyroid hormone27.0 pmol/L (0.9-5.4)
His mother's blood tests were all normal.
What is the most likely diagnosis in this boy?
A. pseudohypoparathyroidism
B. DiGeorge syndrome
C. polyglandular autoimmune syndrome type 1
D. McCune-Albright syndrome
E. pseudopseudohypoparathyroidism
Answer: A
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Exam Name: Endocrinology and Diabetes (Specialty Certificate Examination)

MRCPUK SEND braindumps free demo download pdf braindumps