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

1. A 73-year-old man with type 2 diabetes mellitus was reviewed because of deteriorating
blood glucose control. He was taking metformin 850 mg twice daily.
On examination, his body mass index was 29 kg/m2 (18-25).
Investigations:
serum creatinine102 umol/L (60-110)
haemoglobin A1c66 mmol/mol (20-42)
According to the NICE guidelines (CG87, May 2009), what would be the most appropriate
additional treatment?

A) insulin glargine
B) sulfonylurea
C) sitagliptin
D) thiazolidinedione
E) exenatide

2. A 53-year-old man with a history of sweats and tremor was found to have abnormal thyroid function tests and a small diffuse goitre. He was treated with carbimazole 20 mg but developed a sore throat after 3 weeks.
Investigations:
haemoglobin150 g/L (130-180)
white cell count2.0 ? 109/L (4.0-11.0)
neutrophil count0.4 ? 109/L (1.5-7.0)
serum thyroid-stimulating hormone<0.02 mU/L (0.4-5.0)
serum free T429.0 pmol/L (10.0-22.0)
thyrotropin receptor antibodiespositive
The carbimazole was stopped; his sore throat resolved and the full blood count normalised.
What is the most appropriate next step in management?

A) restart carbimazole 5 mg daily
B) start propylthiouracil 100 mg twice daily
C) early radioactive iodine therapy
D) early partial thyroidectomy
E) treat with Lugol's iodine 5 drops three times daily for 6 months

3. A 36-year-old woman was referred to the endocrine clinic with abnormal thyroid function
tests. She gave a 3-year history of increased sweating and anxiety following an assault and, initially, her symptoms had been attributed to post-traumatic stress disorder.
Investigations:
serum thyroid-stimulating hormone (TSH)3.1 mU/L (0.4-5.0)
serum free T429.8 pmol/L (10.0-22.0)
serum free T33.5 pmol/L (3.0-7.0)
What is the most likely interpretation of her thyroid function test results?

A) resistance to thyroid hormone
B) use of combined oral contraceptive pill
C) TSH-secreting pituitary adenoma
D) assay interference
E) factitious thyrotoxicosis

4. A 67-year-old woman with type 2 diabetes mellitus presented to the foot clinic with an ulcer at the plantar aspect of her fifth left toe. The ulcer probed to bone but there were no signs of inflammation. There had been a little improvement during 6 weeks of podiatric treatment, but there was some concern about possible osteomyelitis. An X-ray of toe 4 weeks previously had been normal.
What is the most appropriate next investigation?

A) CT scan of foot
B) triple phase isotope bone scan
C) MR scan of foot
D) white cell labelled scan
E) plain X-ray of foot

5. A 54-year-old woman was referred for assessment of low bone mineral density. Three months previously, after complaining of bloating and flatulence, she had been found to have coeliac disease and had been started on a gluten-free diet. She had no history of fracture and had not lost height. There was no family history of osteoporosis. Her only medication was omeprazole.
Investigations:
serum corrected calcium2.42 mmol/L (2.20-2.60) serum alkaline phosphatase122 U/L (45-105)
plasma parathyroid hormone7.9 pmol/L (0.9-5.4)
DXA scansee image What is the most appropriate treatment?

A) calcium and vitamin D
B) alendronic acid alone
C) calcium and vitamin D, and intravenous zoledronic acid
D) strontium ranelate
E) alendronic acid, and calcium and vitamin D

Solutions: