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

1. A 26-year-old woman with previously well-controlled primary hypothyroidism had been an in patient for treatment of an eating disorder for the previous 6 weeks. She had a history of anaemia resulting from multiple vitamin deficiency and gastric erosions. She had been taking levothyroxine 125 micrograms daily for the previous 5 years; since admission her medication had also included ferrous sulfate, calcium and vitamin D, and sucralfate. Her daily medicines were taken under supervision at 09.00 h. Although she was eating better and had gained 4 kg in weight, she was now complaining of tiredness and feeling "worse than ever".
On examination, she was thin, slightly pale and had no palpable goitre. Recent blood tests had confirmed that her anaemia had resolved.
Investigations:
serum corrected calcium2.28 mmo/L (2.20-2.60)
serum thryoid-stimulating hormone12.0 mU/L (0.4-5.0)
serum free T48.0 pmol/L (10.0-22.0)
serum T30.90 nmol/L (1.07-3.18)
What is the most appropriate next step in management?

A) stop treatment with calcium and vitamin D
B) increase levothyroxine to 175 micrograms daily
C) administer levothyroxine alone at bedtime
D) add liothyronine 20 micrograms daily
E) no change in treatment

2. A 52-year-old woman had been found to have type 2 diabetes mellitus approximately 6
months previously.
Investigations:
haemoglobin A1c50 mmol/mol (20-42)
What is the lifetime risk of her identical twin sister also developing type 2 diabetes mellitus?

A) 5-10%
B) 40-50%
C) >60%
D) <5%
E) 20-30%

3. A 36-year-old woman was seen in the clinic with a recurrence of hyperthyroidism after a 2year remission. She had been treated with carbimazole for 18 months following her original presentation. She was moderately symptomatic and was keen to be treated in the same way again. She was planning a pregnancy.
Investigations: serum prolactin240 mU/L (<360) serum thyroid-stimulating hormone<0.1 mU/L (0.4-5.0) serum free T428.0 pmol/L (10.0-22.0)
anti-thyroid-stimulating hormone receptor antibodies44 U/L (<7)
What is the most appropriate next step in management?

A) referral for thyroidectomy
B) block-and-replace treatment with carbimazole and levothyroxine
C) propylthiouracil
D) carbimazole
E) radioiodine treatment

4. 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 had type 2 diabetes mellitus that had been well controlled with metformin.
His glucose levels were uncontrolled on metformin powder at maximum dose.
According to the Joint British Diabetes Societies Guidelines (2012), what is the most appropriate next hypoglycaemic agent?

A) insulin detemir
B) insulin glargine
C) premixed (30/70) human insulin
D) gliclazide
E) exenatide

5. A 17-year-old boy was concerned about his height. He had been treated for Crohn's disease since the age of 13 with a combination of topical and systemic corticosteroids and azathioprine. He was currently taking mercaptopurinE.
On examination, his height was on the 25th centile.
Investigations:
X-ray of right kneesee image

What is the most appropriate next step in management?

A) refer for leg lengthening surgery
B) advise him that growth is complete
C) investigate for growth hormone deficiency
D) advise him that he will continue to grow for 12 months
E) treat with growth hormone

Solutions: