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

1. A 35-year-old woman with a 12-year history of type 1 diabetes mellitus was reviewed in the multidisciplinary pump clinic, because her diabetes was treated with an insulin pump. She had a group 2, C1 lorry-driving licence.
Specific driving-related questioning showed that she kept fast-acting carbohydrate in her vehicles and she reported good hypoglycaemic warnings. Data downloaded from her pump indicated significant variability in her blood glucose readings with few results below 2 mmol/L. She declared that this happened occasionally and she was able to explain the events.
According to implementation by the UK of the Third European Union Directive on driving, what is the most appropriate advice?

A) she must surrender her licence for 6 months
B) she must appear before a Driver and Vehicle Licensing Agency-accredited diabetes specialist for assessment within 1 month
C) she should stop driving voluntarily until blood glucose levels increase
D) her licence must be surrendered immediately until further assessment
E) she can continue to drive

2. A 48-year-old man with an 8-year history of type 2 diabetes mellitus was referred because of poor glycaemic control. He had a history of myocardial infarction complicated by previous congestive cardiac failure. His current medication comprised metformin 850 mg three times daily and gliclazide 80 mg once daily. He had gained weight and his body mass index was 31 kg/m2 (18-25).
Investigations:
serum sodium143 mmol/L (137-144)
serum potassium4.4 mmol/L (3.5-4.9)
serum creatinine136 umol/L (60-110)
haemoglobin A1c74 mmol/mol (20-42)
According to NICE guidelines (CG87, May 2009), what is the most appropriate immediate next step in management to improve his glycaemic control?

A) add exenatide
B) add pioglitazone
C) start insulin treatment
D) increase the dose of gliclazide
E) add sitagliptin

3. A 17-year-old girl was referred to the outpatient clinic with irritability, weight loss and difficulty sleeping. At the age of 4, she had presented with rapid growth, breast development and vaginal bleeding. The results of a gonadotropin-releasing hormone (GnRH) stimulation test performed at that time are given below.
serum oestradiolplasma FSHplasma LH
(200-400 pmol/L)(2.5-10.0 U/L)(2.5-10.0 U/L)
0 min365<0.7<0.5
30 min-<0.7<0.5
60 min-<0.7<0.5
She had been treated with GnRH analogue until the age of 11 and puberty had then progressed normally.
On examination, she was found to be tremulous, tachycardic and hyper-reflexic. Several large, irregular cafe-au-lait spots were found.
Investigations:
serum thyroid-stimulating hormone<0.05 mU/L (0.4-5.0)
serum free T436.0 pmol/L (10.0-22.0)
What is the most likely diagnosis?

A) McCune-Albright syndrome
B) multiple endocrine neoplasia type 2
C) Cowden's syndrome
D) neurofibromatosis type 1
E) Carney's complex

4. A 17-year-old boy with a 7-year history of type 1 diabetes mellitus was transferred to the adolescent diabetes clinic. He had a history of poor clinic attendance. He admitted to having lost weight recently. His eyes had been photographed by a community ophthalmologist 1 week previously. A photograph of the right fundus is shown (see image).

Investigations:
haemoglobin A1c104 mmol/mol (20-42)
What is the most likely explanation for the retinal appearance?

A) macular oedema
B) benign choroidal naevus
C) retinitis pigmentosa
D) drusen
E) preproliferative diabetic retinopathy

5. A 62-year-old woman was admitted with right lower lobe pneumonia. She was taking
amiodarone for atrial fibrillation. Routine thyroid function tests were performed.
Investigations:
serum thyroid-stimulating hormone0.3 mU/L (0.4-5.0)
serum free T427.0 pmol/L (10.0-22.0)
serum free T34.2 pmol/L (3.0-7.0)
anti-thyroid peroxidase antibodies32 IU/mL (<50)
What is the most appropriate interpretation of the thyroid function tests?

A) amiodarone-induced thyrotoxicosis type II
B) amiodarone effect in a euthyroid patient
C) subclinical amiodarone-induced thyrotoxicosis
D) amiodarone-induced thyrotoxicosis type I
E) Wolff-Chaikoff effect

Solutions: