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

1. A 69-year-old man with type 2 diabetes mellitus presented with a 3-day history of an ulcer on his right second toe.
On examination, the toe was red, swollen and enlarged, and looked like a 'sausage digit'. The ulcer appeared superficial.
Investigations:
X-ray of right second toeno sign of osteomyelitis
Cultures from the debrided wound bed were taken and the results were awaited.
What is the most appropriate type of antibiotic regimen to start empirically before the culture results are available?

A) broad spectrum for 10 days
B) narrow spectrum for 10 days
C) narrow spectrum for 6 weeks
D) broad spectrum for 6 weeks
E) no antibiotic

2. A 72-year-old man with a dense residual hemiparesis and unsafe swallow was fed via a percutaneous gastrostomy for 20 hours each day. He resided in a nursing home and had type 2 diabetes mellitus that had been well controlled on metformin.
His glucose concentrations were uncontrolled on metformin powder at maximum dose. While not being fed, his blood glucose was measured.
Investigations:
capillary blood glucose3.1 mmol/L
According to the Joint British Diabetes Societies Guidelines (2012), what is the most appropriate management?

A) Glucogel@ ? 2 down gastrostomy tube
B) restart feed to deliver carbohydrate 20 g rapidly
C) glucose 20% 150 mL intravenously
D) Glucogel@ ? 2 given buccally
E) Fortisip@ 110 mL

3. An 85-year-old woman was referred with a lump in her neck. She had no symptoms of thyroid disease.
On examination, she had a 2 ? 3-cm firm mass at the lower pole in the right thyroid lobe. Her resting pulse was 90 beats per minute and regular.
Investigations:
serum thyroid-stimulating hormone3.5 mU/L (0.4-5.0)
serum free T415.0 pmol/L (10.0-22.0)
serum free T36.2 pmol/L (3.0-7.0)
anti-thyroid peroxidase antibodies28 IU/mL (<50) ultrasound scan of thyroidmixed cystic/solid mass with scattered microcalcifications
fine-needle aspiration biopsyThy 3a
What is the most appropriate next step in her management?

A) PET scan of thyroid
B) subtotal thyroidectomy
C) repeat fine-needle aspiration
D) CT scan of neck
E) ablative radioiodine treatment

4. A 56-year-old man was referred to the diabetes clinic for conversion to insulin. He was taking metformin 1 g three times daily, gliclazide 160 mg twice daily and pioglitazone 45 mg daily. He drank no alcohol.
On examination, his body mass index was 41 kg/m2 (18-25). Abdominal examination showed a 2-cm, smooth, non-tender liver edge.
Which liver function test is the best marker of non-alcoholic fatty liver disease in type 2 diabetes mellitus?

A) alanine aminotransferase
B) bilirubin
C) gamma glutamyl transferase
D) aspartate aminotransferase
E) alkaline phosphatase

5. A 43-year-old man was in an ENT ward, having recently undergone removal of a carotid body tumour.
Five years previously, he had undergone a similar procedure in another hospital. He also recalled that his brother had undergone surgery for a similar condition, and that his father, who had since died, might also have had neck surgery.
The ENT surgeons were concerned that there might be an underlying genetic diagnosis.
What is the most likely diagnosis?

A) succinate dehydrogenase A deficiency
B) neurofibromatosis type 1
C) succinate dehydrogenase D deficiency
D) von Hippel-Lindau disease
E) multiple endocrine neoplasia type 2

Solutions: