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

1. A 73-year-old man had been attending the diabetes clinic for 6 weeks with an ulcer on his right second metatarsal head. He had been receiving regular podiatry and offloading.
What new feature in the appearance of his foot is most likely to suggest the need to start antibiotics?

A) tracking sinus
B) skin redness around ulcer
C) pain around ulcer
D) ulcer probing to bone
E) increase in ulcer size

2. A 32-year-old man presented to the fertility clinic with his partner. The couple had been together for 4 years and had been trying to conceive for the past 3 years. His partner had children from a previous marriage.
On examination, he was healthy, thin and tall but had bilateral gynaecomastia. His testes felt firm and testicular volumes were 5-6 mL. He had normal pubic and axillary hair.
Investigations:
serum testosterone10.0 nmol/L (9.0-35.0) plasma follicle-stimulating hormone45.0 U/L (1.0-7.0) plasma luteinising hormone32.0 U/L (1.0-10.0)
chromosomal studiesmosaic pattern of 47 XXY/46 XY
semen analysisazoospermia testicular biopsyno viable spermatozoa
What intervention is most likely to lead to conception?

A) pulsatile gonadotropin-releasing hormone
B) artificial insemination by donor
C) testosterone
D) human chorionic gonadotropin
E) intracytoplasmic sperm injection

3. An 18-year-old woman presented with a 2-month history of polyuria and polydipsia. She
had been previously fit and well with regular periods. She was not taking any contraception.
Investigations:
serum potassium5.2 mmol/L (3.5-4.9)
serum corrected calcium2.30 mmol/L (2.20-2.60)
serum cortisol (09.00 h)350 nmol/L (200-700)
She went on to have a water deprivation test, the results of which are detailed below.
time (h)serum osmolality (mosmol/kg)urine osmolality (mosmol/kg) normal: 278-300normal: 100-1000 08.3028952 11.3029282 14.30301153 15.30-172
She was then given intramuscular DDAVP@ 2 micrograms at 16.00 h.
time (h)serum osmolality (mosmol/kg)urine osmolality (mosmol/kg) normal: 278-300normal: 100-1000 16.3030017.30-530 18.30-532
Results from an MR scan of pituitary are shown (see image).

What is the most likely diagnosis?

A) non-functioning pituitary adenoma
B) Rathke's cleft cyst
C) autoimmune (lymphocytic) hypophysitis
D) psychogenic polydipsia
E) craniopharyngioma

4. A 28-year-old Asian woman was seen in the joint diabetes-antenatal clinic at 16 weeks' gestation. She gave a history of gestational diabetes during her previous pregnancy. She had a strong family history of diabetes mellitus. She was fit and well, and had no symptoms other than slight early morning sickness.
According to NICE guidance (NG3, February 2015) for management of pregnancy, what is the most appropriate way to screen for gestational diabetes in this woman?

A) haemoglobin A1c
B) 2-h postprandial plasma glucose
C) oral glucose tolerance test at 24-28 weeks' gestation
D) fasting plasma glucose
E) oral glucose tolerance test as soon as possible

5. A 36-year-old woman was referred to the endocrine clinic with abnormal thyroid function
tests. She gave a 3-year history of increased sweating and anxiety following an assault and, initially, her symptoms had been attributed to post-traumatic stress disorder.
Investigations:
serum thyroid-stimulating hormone (TSH)3.1 mU/L (0.4-5.0)
serum free T429.8 pmol/L (10.0-22.0)
serum free T33.5 pmol/L (3.0-7.0)
What is the most likely interpretation of her thyroid function test results?

A) resistance to thyroid hormone
B) assay interference
C) factitious thyrotoxicosis
D) use of combined oral contraceptive pill
E) TSH-secreting pituitary adenoma

Solutions: