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

1. A 55-year-old woman was referred with a 6-month history of type 2 diabetes mellitus. She was not taking any regular medication. She was a non-smoker. She drank 10 units of alcohol per week. Her general practitioner had arranged for her to see the community dietician as the patient had made significant changes to her diet.
On examination, she was obese with a body mass index of 31.8 kg/m2 (18-25). Her liver was not palpable.
Investigations:
serum ferritin310 ug/L (15-300)
serum total bilirubin16 umol/L (1-22)
serum alanine aminotransferase80 U/L (5-35)
serum aspartate aminotransferase75 U/L (1-31)
serum alkaline phosphatase150 U/L (45-105)
serum gamma glutamyl transferase35 U/L (4-35)
haemoglobin A1c67 mmol/mol (20-42)
serum cholesterol6.2 mmol/L (<5.2)
serum HDL cholesterol0.90 mmol/L (>1.55)
fasting serum triglycerides2.50 mmol/L (0.45-1.69)
What is the most appropriate management of her dyslipidaemia?

A) omega-3-acid ethyl esters
B) fenofibrate
C) simvastatin
D) metformin
E) ezetimibe

2. Five patients were referred to a rapid access thyroid clinic. Only four slots were available in the following month.
Which patient can safely be deferred to a later clinic?

A) 16-year-old boy with a thyroid nodule
B) 45-year-old woman with a rapidly enlarging painless goitre
C) 67-year-old man with a goitre and hoarseness
D) 44-year-old woman with a history of sudden-onset pain in a thyroid lump
E) 39-year-old woman with a slowly growing thyroid lump and a palpable cervical lymph node

3. A 42-year-old woman presented with a 6-month history of tiredness. She also had a history of hypothyroidism, for which she was taking levothyroxine 150 micrograms daily, and a family history of hyperactivity syndrome.
Examination was normal.
Investigations:
serum thyroid-stimulating hormone12.3 mU/L (0.4-5.0)
serum free T418.0 pmol/L (10.0-22.0)
What is the most likely diagnosis?

A) levothyroxine malabsorption
B) thyroid hormone resistance
C) pituitary thyrotroph adenoma
D) suboptimal prescribed dose of levothyroxine
E) non-adherence with thyroid hormone treatment

4. A 47-year-old nuclear physics professor was referred for advice before taking up an overseas position, overseeing the dismantling of a reactor at the site of a recent nuclear accident. She stated that she would face a small risk of being exposed to significant radioactive contamination during her work and was concerned about her future risk of thyroid cancer.
What is the most appropriate advice?

A) take potassium iodide tablets
B) no precautions are necessary for people aged 40 years or over
C) avoid consuming local milk and vegetables
D) take selenium tablets
E) wear lead neck shield while outdoors

5. A 52-year-old man had been found to have type 1 diabetes mellitus at the age of 25. He had developed retinopathy at the age of 31 and a painless foot ulcer at the age of 40. His renal function had subsequently deteriorated.
On examination, urinalysis showed protein 1+, glucose 2+.
What is the most likely diagnosis?

A) focal segmental glomerulosclerosis
B) minimal change glomerulonephritis
C) tubulointerstitial nephritis
D) membranoproliferative glomerulonephritis
E) nodular glomerulosclerosis

Solutions: