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

1. A 54-year-old woman was referred for assessment of low bone mineral density. Three months previously, after complaining of bloating and flatulence, she had been found to have coeliac disease and had been started on a gluten-free diet. She had no history of fracture and had not lost height. There was no family history of osteoporosis. Her only medication was omeprazole.
Investigations:
serum corrected calcium2.42 mmol/L (2.20-2.60) serum alkaline phosphatase122 U/L (45-105)
plasma parathyroid hormone7.9 pmol/L (0.9-5.4)
DXA scansee image What is the most appropriate treatment?

A) alendronic acid alone
B) calcium and vitamin D
C) strontium ranelate
D) alendronic acid, and calcium and vitamin D
E) calcium and vitamin D, and intravenous zoledronic acid

2. A 56-year-old man was referred to the diabetes clinic for conversion to insulin. He was taking metformin 1 g three times daily, gliclazide 160 mg twice daily and pioglitazone 45 mg daily. He drank no alcohol.
On examination, his body mass index was 41 kg/m2 (18-25). Abdominal examination showed a 2-cm, smooth, non-tender liver edge.
Which liver function test is the best marker of non-alcoholic fatty liver disease in type 2 diabetes mellitus?

A) alanine aminotransferase
B) gamma glutamyl transferase
C) aspartate aminotransferase
D) bilirubin
E) alkaline phosphatase

3. A 62-year-old woman was admitted with right lower lobe pneumonia. She was taking
amiodarone for atrial fibrillation. Routine thyroid function tests were performed.
Investigations:
serum thyroid-stimulating hormone0.3 mU/L (0.4-5.0)
serum free T427.0 pmol/L (10.0-22.0)
serum free T34.2 pmol/L (3.0-7.0)
anti-thyroid peroxidase antibodies32 IU/mL (<50)
What is the most appropriate interpretation of the thyroid function tests?

A) amiodarone-induced thyrotoxicosis type II
B) Wolff-Chaikoff effect
C) amiodarone effect in a euthyroid patient
D) amiodarone-induced thyrotoxicosis type I
E) subclinical amiodarone-induced thyrotoxicosis

4. A 48-year-old man presented with gynaecomastia. His serum oestradiol was increased and a CT scan of adrenal glands revealed a 13-cm tumour of the left adrenal gland. Further workup showed increased secretion of 17-hydroxyprogesterone, cortisol and androstenedione. A diagnosis of adrenocortical carcinoma was suspected.
Investigations:
staging CT scan of chest and abdomenno evidence of metastasis
What is the most appropriate next step in management?

A) adrenal fine-needle biopsy
B) MR scan of adrenal glands with chemical shift analysis
C) left adrenalectomy followed by adjuvant mitotane treatment
D) iodocholesterol scan
E) left adrenalectomy followed by adjuvant combination chemotherapy

5. A 72-year-old woman was referred for bone density assessment after sustaining a fracture of her right ankle after a minor fall. She had previously fractured her right wrist after tripping in the street. Her past medical history included occasional angina relieved by glyceryl trinitrate spray and a previous deep venous thrombosis. Her medication comprised aspirin, simvastatin, alendronic acid, and calcium and vitamin D, which she had been taking regularly for 2 years.
Investigations:
DXA scan of spine (L2-L4)T score -2.4
DXA scan of total hipT score -2.8
What is the most appropriate treatment?

A) switch alendronic acid to pamidronate
B) switch alendronic acid to raloxifene
C) switch alendronic acid to strontium ranelate
D) continue alendronic acid
E) switch alendronic acid to teriparatide

Solutions: