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

1. A 25-year-old woman who was 4 months pregnant presented with weight loss of 3 kg over the previous 4 weeks, associated with intermittent palpitations, tremor and feeling of warmth. She was not taking any medication.
On examination, her pulse was 100 beats per minute and regular, and her blood pressure was 130/60 mmHg. A symmetrical non-tender goitre was palpable, with an audible bruit. There was no exophthalmos.
Investigations:
serum thyroid-stimulating hormone<0.1 mU/L (0.4-5.0)
serum free T445.2 pmol/L (10.0-22.0)
serum free T322.8 pmol/L (3.0-7.0)
anti-thyroid stimulating hormone receptor
antibodies40 U/L (<7)
What is the most appropriate treatment?

A) carbimazole
B) subtotal thyroidectomy
C) propranolol
D) propylthiouracil
E) radioactive iodine

2. A 34-year-old man was referred to the diabetes outpatient clinic with impaired glucose tolerance. He had a family history of diabetes mellitus and had a body mass index of 34.6 kg/m2 (18-25).
On examination, his blood pressure was 140/82 mmHg.
He wished to delay the onset of frank diabetes mellitus.
What is the most effective way of achieving this outcome?

A) ramipril
B) acarbose
C) lifestyle changes aimed at weight loss
D) metformin
E) orlistat

3. A 33-year-old woman, who was 9 weeks into her first pregnancy, was admitted with prolonged vomiting and secondary dehydration. She had lost 6 kg in weight since becoming pregnant. There was a strong family history of thyroid disease: two sisters were hypothyroid and one brother had required radioactive iodine for Graves' disease.
On examination, she had a smooth, small goitre. Her pulse was 94 beats per minute and her blood pressure was 104/42 mmHg. There was a tremor of the outstretched hands. Urinalysis was normal.
Investigations:
serum sodium143 mmol/L (137-144) serum potassium4.4 mmol/L (3.5-4.9)
serum creatinine105 umol/L (60-110)
serum thyroid-stimulating hormone (TSH)<0.01 mU/L (0.4-5.0)
serum free T424.0 pmol/L (10.0-22.0)
serum free T311.0 pmol/L (3.0-7.0)
A TSH receptor antibody concentration was awaited.
In addition to rehydration, what is the most appropriate next step in the management of her abnormal thyroid function?

A) carbimazole
B) labetalol
C) observation
D) propranolol
E) propylthiouracil

4. A 56-year-old man attended routine follow-up for treatment of hypogonadism of late onset. His only medication was testosterone undecanoate (1 g intramuscular injection, every 12 weeks). He had started this treatment 12 months previously and last received the injection 1 week before review.
Digital rectal examination was normal.
Investigations (baseline): haemoglobin145 g/L (130-180) haematocrit0.46 (0.40-0.52) serum prostate-specific antigen0.6 ug/L (<4)
Investigations (12 months after treatment):
haemoglobin153 g/L (130-180) haematocrit0.51 (0.40-0.52) serum prostate-specific antigen5.1 ug/L (<4)
What is the most appropriate next step in management?

A) check serum testosterone
B) stop testosterone therapy
C) decrease testosterone injection frequency to 14 weeks
D) reassure and repeat blood tests in 12 months
E) refer for urological assessment

5. A 30-year-old man was reviewed in the diabetes clinic. He had type 1 diabetes mellitus of 6 months' duration, treated with subcutaneous insulin in a basal bolus regimen (short-acting insulin three times daily; long-acting insulin once daily).
Investigations:
haemoglobin A1c52 mmol/mol (20-42)
At what arterialised venous blood glucose threshold would a patient typically expect to develop neuroglycopenic symptoms?

A) 3.5-3.9 mmol/L
B) 2.7-3.0 mmol/L
C) 3.1-3.4 mmol/L
D) <2.3 mmol/L
E) 2.3-2.6 mmol/L

Solutions: