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

1. A 25-year-old woman presented with a solitary nodule in the right lobe of her thyroid gland.
Investigations:
serum thyroid-stimulating hormone0.45 mU/L (0.4-5.0)
serum free T420.7 pmol/L (10.0-22.0)
The presence of which feature would most increase the likelihood of malignancy?

A) increased peripheral vascularity of nodule on Doppler ultrasound
B) elevated serum thyroglobulin concentration
C) high titre of thyroid peroxidase antibodies
D) microcalcification seen within the nodule on ultrasound scan
E) size of nodule >1.0 cm in maximum diameter

2. A 64-year-old man was referred to the foot clinic. He had tripped over his cat 1 week previously and had complained of an ache in his left foot since then. He had a 12-year history of type 2 diabetes mellitus and hypertension. He was taking metformin, gliclazide, pioglitazone, bendroflumethiazide, ramipril, simvastatin and aspirin.
On examination, his blood pressure was 154/88 mmHg. Foot examination showed absent vibration perception to his ankle. The dorsalis pedis and posterior tibial pulses were easily palpable on both feet.
Investigations:
serum urea12.6 mmol/L (2.5-7.0) serum creatinine166 umol/L (60-110) haemoglobin A1c79 mmol/mol (20-42)
urinary albumin:creatinine ratio8.7 mg/mmol (<2.5)
X-ray of left footsee image

What is the most appropriate initial management for this deformity?

A) removable aircast boot
B) custom-made hospital footwear
C) full contact plaster cast
D) bed rest
E) referral for urgent surgery

3. A 16-year-old Caucasian girl presented with a 4-year history of facial hair growth, acne and secondary amenorrhoea.
On examination, her body mass index was 20 kg/m2 (18-25). Her gums and palmar creases were pigmented. Facial hair was evident on her upper lip and chin, and terminal hair was evident on her chest and abdomen. Her Ferriman-Gallwey score was 25. She had acne affecting her face and back.
Investigations:
serum dehydroepiandrosterone sulphate15 umol/L (3-12)
serum androstenedione12.2 nmol/L (0.6-8.8)
serum 17-hydroxyprogesterone120 nmol/L (1-10)
serum testosterone6.0 nmol/L (0.5-3.0)
serum sex hormone binding globulin18 nmol/L (40-137)
What treatment is likely to be of most benefit?

A) flutamide
B) metformin
C) hydrocortisone
D) fludrocortisone
E) cyproterone acetate

4. A 28-year-old woman presented to the emergency department with a 3-day history of abdominal pain. Her past medical history included intermenstrual bleeding, and she was undergoing 6-monthly renal ultrasound surveillance for a cystic lesion.
Investigations:
serum creatinine84 umol/L (60-110)
serum corrected calcium3.20 mmol/L (2.20-2.60)
serum phosphate0.7 mmol/L (0.8-1.4)
plasma parathyroid hormone19.5 pmol/L (0.9-5.4)
What is the most likely condition underlying the clinical presentation?

A) Cowden's syndrome
B) multiple endocrine neoplasia type 1
C) hyperparathyroidism-jaw tumour syndrome
D) multiple endocrine neoplasia type 2B
E) von Hippel-Lindau syndrome

5. A 17-year-old boy with a 10-year history of type 1 diabetes mellitus was admitted with diabetic ketoacidosis after a night of binge drinking.
He was treated appropriately with a fixed-rate intravenous insulin infusion and intravenous sodium chloride 0.9%.
Twenty-four hours after admission, he was eating and drinking normally. He was taking his usual doses of subcutaneous insulin and his urinary ketones were undetectable.
Investigations (6 hours previously):
venous blood gases, breathing air: PO25.6 kPa PCO23.8 kPa pH7.29 bicarbonate16 mmol/L base excess-1 mmol/L
lactate1.1 mmol/L
What is the likely most cause of these results?

A) continued ketonaemia
B) hyporeninaemic hypoaldosteronism
C) concurrent aspirin ingestion
D) hyperchloraemia
E) alcohol toxicity

Solutions: