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

1. A 72-year-old man with a dense residual hemiparesis and unsafe swallow was fed via a percutaneous gastrostomy for 20 hours each day. He resided in a nursing home and had type 2 diabetes mellitus that had been well controlled on metformin.
His glucose concentrations were uncontrolled on metformin powder at maximum dose. While not being fed, his blood glucose was measured.
Investigations:
capillary blood glucose3.1 mmol/L
According to the Joint British Diabetes Societies Guidelines (2012), what is the most appropriate management?

A) Glucogel@ ? 2 down gastrostomy tube
B) restart feed to deliver carbohydrate 20 g rapidly
C) Fortisip@ 110 mL
D) Glucogel@ ? 2 given buccally
E) glucose 20% 150 mL intravenously

2. A 49-year-old woman presented with a mass in her neck that was causing no specific symptoms.
Examination revealed a solitary nodule in the right thyroid lobe, with no associated lymphadenopathy. Thyroid function was normal. No other abnormality was noted. There was no evidence of lymphadenopathy in the neck.
Investigations:
ultrasound scan of necksolid hypoechoic nodule 1.8 ? 1.2 ? 1 cm
in right thyroid lobe;
cyst 0.6 ? 0.3 ? 0.2 cm in left thyroid lobe
cytology (fine-needle aspirationscanty colloid with abundant
from nodule in right lobe)thyroid follicular cells (Thy3f)
What is the most appropriate next step in management?

A) repeat cytology for confirmation
B) total thyroidectomy for histological diagnosis
C) thyroid lobectomy for histological diagnosis
D) serum thyroglobulin
E) reassure that the nodule is not malignant and discharge

3. A 26-year-old man presented urgently, complaining of muscle pains. He had been found to have heterozygous familial hypercholesterolaemia 2 years previously owing to a mutation in the PCSK9 gene. He had a strong family history of premature vascular disease. He was taking atorvastatin 80 mg daily.
Investigations:
serum creatine kinase2782 U/L (24-195)
serum cholesterol5.7 mmol/L (<5.2)
After stopping atorvastatin, his serum creatine kinase fell to within the normal range.
What is the most appropriate next step in management?

A) start fenofibrate 100 mg
B) start fluvastatin 40 mg
C) restart atorvastatin 40 mg
D) restart atorvastatin 10 mg
E) start ezetimibe 10 mg

4. A 36-year-old man of African origin attended the clinic 2 weeks after discharge from hospital following his first admission with diabetic ketoacidosis. He had made a rapid recovery and had been discharged taking subcutaneous insulin twice daily.
At clinic, he reported home blood glucose measurements of 4-6mmol/L, occasional symptomatichypoglycaemia and a total daily insulin dose of 12 units. He asked if his glucose-lowering treatment should change.
Which test is most likely to predict prolonged insulin independence?

A) genotyping for monogenic diabetes
B) anti-islet cell antibodies
C) anti-glutamic acid decarboxylase antibodies
D) glucagon-stimulated C-peptide concentration
E) fasting C-peptide concentration

5. A 35-year-old woman was referred with a left lower thyroid lesion. She was asymptomatic.
Examination confirmed the presence of a 2 ? 3-cm, firm, mobile, non-tender mass.
Investigations:
ultrasound-guided fine-needle aspiration biopsyThy 5
How is Thy 5 defined?

A) abnormal, diagnostic of malignancy
B) non-neoplastic (consistent with nodular goitre or thyroiditis)
C) non-diagnostic or inadequate
D) abnormal, suspicious (but not diagnostic of) malignancy
E) follicular lesions

Solutions: