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

1. A 32-year-old man presented with persistent thirst. He had a past history of polydactyly, which had been corrected surgically in infancy. His family had remarked about his recent weight gain. His only concern was of blurring of vision and difficulty reading. His father and paternal grandfather had each developed type 2 diabetes mellitus when aged 41 and 56 years, respectively.
His body mass index was 34 kg/m2 (18-25). Urinalysis showed glucose 2+, ketones 1+.
Investigations:
serum sodium142 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)
haemoglobin A1c91 mmol/mol (20-42)
random plasma glucose11.3 mmol/L
ultrasound scan of kidneysnormal
What is the most likely underlying diagnosis?

A) monogenic diabetes caused by a mutation in the HNF-1? gene
B) Prader-Willi syndrome
C) type 2 diabetes mellitus
D) Bardet-Biedl syndrome
E) monogenic diabetes caused by a mutation in the glucokinase gene

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

3. A 50-year-old woman noticed some swelling of her right great toe and a painful right foot. She had type 1 diabetes mellitus of 21 years' duration and recent screening had revealed some mild diabetic retinal changes and peripheral neuropathy.
On examination, she had a hot, red right forefoot with swelling of the great toe. There was callus on the first metatarsal head with a blister beneath it. After de-roofing, the podiatrist probed to a depth of 1 cm. The left foot demonstrated reduced sensation to a 10-g monofilament. Her right foot was 0.6C hotter than the left.
What is the most likely diagnosis?

A) gout
B) Charcot's foot
C) osteomyelitis
D) necrotising fasciitis
E) osteoarthritis

4. A 17-year-old girl with Turner's syndrome attended the clinic for review. She had been treated with growth hormone therapy for the previous 7 years, and had now reached her final adult height.
What is the most appropriate next step in management?

A) withdraw growth hormone therapy for 3 months and evaluate growth hormone secretion
B) continue growth hormone until 25 years old then reassess
C) assess her bone density by DXA scan and continue growth hormone if bone mineral density is less than mean for age
D) start to reduce growth hormone therapy with a view to discontinuing in 2 years' time
E) stop growth hormone therapy

5. A 32-year-old woman with a recurrent history of Graves' thyrotoxicosis was being considered for radioiodine treatment. However, she wanted to conceive again at some stage and asked how soon she could become pregnant.
After what minimum interval would it be safe for her to conceive again?

A) 6 months
B) 12 months
C) 4 months
D) 2 months
E) 8 months

Solutions: