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

1. A 48-year-old man was investigated for a 6-month history of tiredness. There was no other medical history and he was taking no medication.
Investigations:
estimated glomerular filtration rate (MDRD)36 mL/min/1.73 m2 (>60) serum corrected calcium2.25 mmol/L (2.20-2.60) serum phosphate1.1 mmol/L (0.8-1.4)
plasma parathyroid hormone8.1 pmol/L (0.9-5.4) serum 25-OH-cholecalciferol48 nmol/L (45-90)
What is the most important next step in management?

A) reassure and discharge from clinic
B) refer for parathyroidectomy
C) reassure and repeat in 3 months
D) refer for nephrological advice
E) prescribe calcium and vitamin D supplements

2. A 43-year-old woman was admitted with right lower lobe pneumonia and was found to have atrial fibrillation. She had a history of bipolar disorder for which she was taking lithium. Her menstrual periods were normal.
Investigations on admission:
serum thyroid-stimulating hormone (TSH)0.98 mU/L (0.4-5.0)
serum free T428.1 pmol/L (10.0-22.0)
serum free T314.2 pmol/L (3.0-7.0)
Assay interference had been excluded.
Subsequent investigations:
serum sex hormone binding globulin64 nmol/L (40-137)
serum thyroid-hormone receptor ?-subunit0.8 IU/L (<1.0)
anti-thyroid peroxidase antibodiesnegative
What is the most likely diagnosis?

A) TSHoma
B) thyroid hormone resistance
C) lithium-induced hyperthyroidism
D) surreptitious ingestion of thyroxine
E) non-thyroidal illness (sick euthyroid syndrome)

3. A 56-year-old man with a 5-year history of type 2 diabetes mellitus was worried about developing a foot ulcer.
Which clinical feature, if present, best predicts the development of a foot ulcer in a patient with diabetes?

A) absent sensation to a monofilament
B) absent foot pulses
C) inability to perform own foot care
D) vibration perception threshold >25v
E) history of a previous foot ulcer

4. A 55-year-old woman presented with thirst, polyuria and polydipsia. Her symptoms had started 9 months previously following a road traffic accident. Her past medical history was normal and she was not taking any regular medication.
On examination, her blood pressure was 130/80 mmHg with no postural drop. Urine volume measured 5 L in 24 hours.
Investigations:
serum sodium131 mmol/L (137-144) serum potassium3.6 mmol/L (3.5-4.9) serum urea2.0 mmol/L (2.5-7.0) serum corrected calcium2.40 mmol/L (2.20-2.60) fasting plasma glucose6.4 mmol/L (3.0-6.0) serum osmolality278 mosmol/kg (278-300) urinary osmolality100 mosmol/kg (100-1000)
What is the most likely diagnosis?

A) cranial diabetes insipidus
B) nephrogenic diabetes insipidus
C) diabetes mellitus
D) syndrome of inappropriate antidiuretic hormone
E) primary polydipsia

5. A 36-year-old man of South Asian origin presented acutely with a widespread pruritic rash involving the extensor surfaces of the limbs.
On examination, he was moderately obese with a body mass index of 33 kg/m2 (18-25), and the rash was erythematous, with multiple small papules with yellow centres.
Investigations:
fasting plasma glucose11.0 mmol/L (3.0-6.0)
haemoglobin A1c109 mmol/mol (20-42)
serum cholesterol8.0 mmol/L (<5.2)
serum HDL cholesterol0.80 mmol/L (>1.55)
fasting serum triglycerides31.00 mmol/L (0.45-1.69)
What is the most likely diagnosis?

A) eruptive xanthoma
B) tinea cutis
C) granuloma annulare
D) dermatitis herpetiformis
E) nodular prurigo

Solutions: