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

1. A 55-year-old dental nurse was referred for bone densitometry after sustaining a non-displaced fracture of the femur after falling down a step. She had experienced no other fractures. Her only medical problem was long-standing anaemia of unknown cause. The only family history was of persistent dental abscesses affecting her father. She had three children who were well. She was taking no medication.
Examination was normal.
Investigations:
haemoglobin102 g/L (115-165)
MCV85 fL (80-96)
white cell count6.0 ? 109/L (4.0-11.0)
platelet count245 ? 109/L (150-400)
erythrocyte sedimentation rate25 mm/1st h (<30)
serum creatinine85 umol/L (60-110)
serum corrected calcium2.40 mmol/L (2.20-2.60)
serum alkaline phosphatase56 U/L (45-105)
DXA scan spine (L2-L4)T score +5.8
DXA scan total hipT score +5.4
What is the most likely diagnosis?

A) Paget's disease
B) osteopetrosis
C) fluorosis
D) high bone mass phenotype
E) myelodysplasia

2. A 16-year-old boy was referred to the endocrine clinic with symptoms of delayed puberty.
On examination, he had a reduced sense of smell, small-sized testes and underdeveloped
secondary sexual characteristics.
Investigations:
serum testosterone3.5 nmol/L (9.0-35.0)
serum follicle-stimulating hormone1.0 U/L (1.0-7.0)
serum luteinising hormone1.5 U/L (1.0-10.0)
serum prolactin220 mU/L (<360)
MR scan of brainnormal
He asked about his future fertility.
What will be the most useful agent for him to achieve fertility?

A) bromocriptine
B) testosterone
C) octreotide
D) clomifene
E) gonadotropin-releasing hormones

3. Carbimazole is routinely used in the management of thyroid disease.
What does carbimazole inhibit?

A) sodium/iodide symporter
B) thyroid peroxidase
C) deiodinase type 1
D) thyroglobulin synthesis
E) presentation of thyroid antigens to autoreactive T cells

4. A 42-year-old motor mechanic was referred to the dermatologist with small cauliflower-like deposits on the points of his elbows. He was generally well, but on systemic enquiry, he described intermittent claudication. He had previously been hypertensive, and was taking thyroxine for primary hypothyroidism.
On examination, he was moderately obese. He had xanthelasmata on the upper eyelids of both eyes and tuberoeruptive xanthomata on both elbows, both knees and the nape of the neck.
Investigations:
serum alanine aminotransferase78 U/L (5-35)
fasting plasma glucose7.8 mmol/L (3.0-6.0)
serum urate0.48 mmol/L (0.23-0.46)
serum cholesterol13.4 mmol/L (<5.2)
serum LDL cholesterolnot measurable
serum HDL cholesterol0.90 mmol/L (>1.55)
fasting serum triglycerides9.32 mmol/L (0.45-1.69)
apolipoprotein E genotypehomozygous for apolipoprotein E2
What is the most likely diagnosis?

A) familial combined hyperlipidaemia
B) type III hyperlipidaemia (dysbetalipoproteinaemia)
C) abetalipoproteinaemia
D) heterozygous familial hypercholesterolaemia
E) lipoprotein lipase deficiency

5. A 32-year-old man presented to the emergency department after becoming acutely unwell. He had a 5-year history of type 1 diabetes mellitus and no other significant medical history.
On examination, he was apyrexial, his pulse was 120 beats per minute, his blood pressure was 96/58 mmHg and his respiratory rate was 32 breaths per minute.
Investigations:
random plasma glucose14.2 mmol/L
arterial blood gases, breathing 60% oxygen:
PO28.9 kPa (11.3-12.6)
PCO22.6 kPa (4.7-6.0)
pH7.10 (7.35-7.45)
H+79 nmol/L (35-45)
bicarbonate6.1 mmol/L (21-29)
base excess-18 mmol/L (+-2)
What diagnosis is most likely to account for these results?

A) acute myocardial infarction
B) diabetic ketoacidosis
C) diabetic ketoacidosis and pulmonary embolism
D) acute asthma
E) salicylate poisoning

Solutions: