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

1. 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%
B) 40-50%
C) 5-10%
D) 20-30%
E) >60%

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

3. A 76-year-old woman with type 2 diabetes mellitus was reviewed. Treatment with thiazolidinedione was being considered, but she was worried about the effect this medication might have on the incidence of complications. She had known background retinopathy.
What complication is more likely to worsen in a patient taking a thiazolidinedione?

A) macular oedema
B) retinal haemorrhages
C) retinal vein thrombosis
D) cataract
E) hard exudates

4. A 47-year-old nuclear physics professor was referred for advice before taking up an overseas position, overseeing the dismantling of a reactor at the site of a recent nuclear accident. She stated that she would face a small risk of being exposed to significant radioactive contamination during her work and was concerned about her future risk of thyroid cancer.
What is the most appropriate advice?

A) no precautions are necessary for people aged 40 years or over
B) avoid consuming local milk and vegetables
C) take selenium tablets
D) take potassium iodide tablets
E) wear lead neck shield while outdoors

5. A 33-year-old woman presented with tiredness, palpitations, weight loss and emotional
lability 9 weeks after the birth of her third child.
On examination, she had a sinus tachycardia, a fine tremor, slight lid retraction and a mild
diffuse non-tender goitre.
Investigations:
serum thyroid-stimulating hormone<0.01 mU/L (0.4-5.0)
serum free T434.3 pmol/L (10.0-22.0)
technetium-99m scan of thyroid (20-min uptake)<1% (0.4-3.0)
What is the most appropriate treatment?

A) propylthiouracil
B) propranolol
C) carbimazole
D) potassium perchlorate
E) aqueous iodine oral solution

Solutions: