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

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

2. A 64-year-old man was referred to the foot clinic. He had tripped over his cat 1 week previously and had complained of an ache in his left foot since then. He had a 12-year history of type 2 diabetes mellitus and hypertension. He was taking metformin, gliclazide, pioglitazone, bendroflumethiazide, ramipril, simvastatin and aspirin.
On examination, his blood pressure was 154/88 mmHg. Foot examination showed absent vibration perception to his ankle. The dorsalis pedis and posterior tibial pulses were easily palpable on both feet.
Investigations:
serum urea12.6 mmol/L (2.5-7.0) serum creatinine166 umol/L (60-110) haemoglobin A1c79 mmol/mol (20-42)
urinary albumin:creatinine ratio8.7 mg/mmol (<2.5)
X-ray of left footsee image

What is the most appropriate initial management for this deformity?

A) bed rest
B) removable aircast boot
C) custom-made hospital footwear
D) referral for urgent surgery
E) full contact plaster cast

3. A 26-year-old man was referred from the sexual health clinic, after small testes had been noted during treatment for genital warts. The patient reported recent loss of libido but there was no history of erectile dysfunction or delayed pubertal development. He was taking no regular medication. Approximately 3 years before presentation, he had taken anabolic steroids for 6 months to improve his muscle bulk.
On examination, normal facial, axillary and pubic hair was present. Testicular volume was 6 mL and his testes were firm.
Investigations:
serum testosterone4.0 nmol/L (9.0-35.0)
plasma follicle-stimulating hormone21.0 U/L (1.0-7.0)
plasma luteinising hormone23.0 U/L (1.0-10.0)
serum prolactin420 mU/L (<360)
What is the most likely diagnosis?

A) microprolactinoma
B) Kallmann's syndrome
C) haemochromatosis
D) exogenous anabolic steroid use
E) Klinefelter's syndrome

4. A 25-year-old woman who was 4 months pregnant presented with weight loss of 3 kg over the previous 4 weeks, associated with intermittent palpitations, tremor and feeling of warmth. She was not taking any medication.
On examination, her pulse was 100 beats per minute and regular, and her blood pressure was 130/60 mmHg. A symmetrical non-tender goitre was palpable, with an audible bruit. There was no exophthalmos.
Investigations:
serum thyroid-stimulating hormone<0.1 mU/L (0.4-5.0)
serum free T445.2 pmol/L (10.0-22.0)
serum free T322.8 pmol/L (3.0-7.0)
anti-thyroid stimulating hormone receptor
antibodies40 U/L (<7)
What is the most appropriate treatment?

A) radioactive iodine
B) subtotal thyroidectomy
C) propranolol
D) propylthiouracil
E) carbimazole

5. A 33-year-old woman was reviewed in the insulin pump clinic. She had had type 1 diabetes mellitus for 10 years. She had been treated with a continuous subcutaneous insulin infusion 3 years previously, because of frequent hypoglycaemic episodes. She had recently undergone continuous glucose monitoring (see image).

Investigations:
haemoglobin A1c43 mmol/mol (20-42)
What is the most likely cause of the blood glucose trace seen between 08.00 h and 10.00 h?

A) dawn phenomenon
B) inadequate mealtime insulin bolus
C) inadequate basal insulin rate
D) overcorrection of hypoglycaemia
E) blocked infusion set

Solutions: