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

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

2. A 39-year-old woman with Graves' disease was considered suitable for treatment with radioiodine. She was keen that her thyrotoxicosis should not recur. The plan was to request a 600 MBq dose.
What is the probability of resolution of thyrotoxicosis with this dose?

A) 40%
B) >95%
C) 80%
D) 60%
E) 20%

3. A 56-year-old woman presented with a swelling in her neck, which she had noticed by chance 6 weeks previously. The swelling had not changed in size since she first noticed it, and was completely asymptomatic.
On examination, there was a smooth nodule in the thyroid that moved up on swallowing and there was no lymphadenopathy.
Investigations:
ultrasound scan of thyroidsingle 4.7-cm hypoechoic nodule
in upper left lobe
serum thyroid-stimulating hormone0.8 mU/L (0.4-5.0)
What is the most appropriate next step in management?

A) isotope uptake scan
B) fine-needle aspiration for cytology
C) hemithyroidectomy
D) serial ultrasound examinations
E) FDG-PET CT scan

4. A 43-year-old man was in an ENT ward, having recently undergone removal of a carotid body tumour.
Five years previously, he had undergone a similar procedure in another hospital. He also recalled that his brother had undergone surgery for a similar condition, and that his father, who had since died, might also have had neck surgery.
The ENT surgeons were concerned that there might be an underlying genetic diagnosis.
What is the most likely diagnosis?

A) succinate dehydrogenase D deficiency
B) succinate dehydrogenase A deficiency
C) neurofibromatosis type 1
D) von Hippel-Lindau disease
E) multiple endocrine neoplasia type 2

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

Solutions: