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

1. A 67-year-old man underwent an isotope bone scan after being found to have a raised serum alkaline phosphatase (of bone origin). The blood test had been ordered because of mild lower back pain, which had now resolved. He was not taking any medication.
Examination was normal.
Investigations:
isotope bone scansee image

What is the most likely diagnosis?

A) osteomalacia
B) fibrous dysplasia
C) Paget's disease
D) multiple myeloma
E) prostate cancer

2. A 62-year-old man with newly diagnosed type 2 diabetes mellitus presented with weight loss and anaemia.
On examination, the only abnormalities were evidence of recent weight loss and a red-brown rash on his lower limbs. Urinalysis showed glucose 3+.
Investigations:
serum total bilirubin19 umol/L (1-22) serum aspartate aminotransferase26 U/L (1-31) serum alkaline phosphatase98 U/L (45-105) serum gamma glutamyl transferase26 U/L (<50)
plasma gastrin21 pmol/L (<55)
plasma glucagon246 pmol/L (<50)
plasma pancreatic polypeptide158 pmol/L (<300)
plasma vasoactive intestinal polypeptide12 pmol/L (<30)
chromogranin A214 U/L (<40)
serum thyroid-stimulating hormone4.9 mU/L (0.4-5.0)
serum free T49.1 pmol/L (10.0-22.0)
CT scan of abdomen2-cm mass in the tail of the pancreas
What is the most likely explanation for the rash?

A) necrolytic migratory erythema
B) necrobiosis lipoidica diabeticorum
C) acrodermatitis enteropathica
D) cutaneous metastasis
E) pellagra

3. A 32-year-old woman with a recurrent history of Graves' thyrotoxicosis was being considered for radioiodine treatment. However, she wanted to conceive again at some stage and asked how soon she could become pregnant.
After what minimum interval would it be safe for her to conceive again?

A) 4 months
B) 6 months
C) 12 months
D) 8 months
E) 2 months

4. A 35-year-old man presented with newly diagnosed type 2 diabetes mellitus. He had no medical history of note.
When should he inform the UK Driver and Vehicle Licensing Agency (DVLA) of his medical condition?

A) if he becomes unable to read a car number plate with one eye at 20.5 m
B) if he requires laser treatment to one eye
C) immediately
D) if he starts using basal night-time insulin
E) if he starts taking an oral hypoglycaemic agent

5. A 56-year-old man attended routine follow-up for treatment of hypogonadism of late onset. His only medication was testosterone undecanoate (1 g intramuscular injection, every 12 weeks). He had started this treatment 12 months previously and last received the injection 1 week before review.
Digital rectal examination was normal.
Investigations (baseline): haemoglobin145 g/L (130-180) haematocrit0.46 (0.40-0.52) serum prostate-specific antigen0.6 ug/L (<4)
Investigations (12 months after treatment):
haemoglobin153 g/L (130-180) haematocrit0.51 (0.40-0.52) serum prostate-specific antigen5.1 ug/L (<4)
What is the most appropriate next step in management?

A) stop testosterone therapy
B) decrease testosterone injection frequency to 14 weeks
C) reassure and repeat blood tests in 12 months
D) check serum testosterone
E) refer for urological assessment

Solutions: