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

1. A 54-year-old man was referred to the diabetes foot clinic with a plantar foot ulcer of 3 months' duration under the right first metatarsal head. He had a 10-year history of type 2 diabetes mellitus. He lived alone and had to do his own shopping and cleaning.
On examination, the ulcer was 3 ? 2 cm in area, 4 mm in depth, and had a clean granulating base. He had strong palpable pedal pulses and sensory neuropathy in both feet.
What is the most effective intervention to heal this ulcer?

A) total contact casting
B) long-term oral antibiotics
C) ambulatory vacuum-assisted pump therapy
D) Manuka honey-impregnated wound dressing
E) removable pressure-relieving boot

2. A 77-year-old woman presented with acute severe pain in the mid-thoracic spine after lifting a heavy bag of shopping. She had reported losing 6 cm in height over the preceding 5 years.
On examination, she was of slight build and experienced difficulty rising from a chair. There was tenderness in the region of T9/10.
Investigations:
plain thoracic X-ray of spinewedge fracture of T10
DXA scanT score -2.7 at L1-L4 and -2.3 at
the left total hip
What is the best estimate for the proportion of vertebral fractures that present clinically with back pain, as seen in this patient?

A) <1%
B) 60%
C) 5%
D) 25%
E) 90%

3. A 55-year-old man with mild polyuria and tiredness was seen on a renal ward. He had had a living-related kidney transplant 6 months previously. He had good graft function while being treated with prednisolone 5 mg daily, mycophenolate mofetil 1 g twice daily and tacrolimus 3 mg twice daily. He was also taking atenolol 50 mg daily and simvastatin 40 mg daily.
Investigations:
haemoglobin A1c75 mmol/mol (20-42)
random plasma glucose18.0 mmol/L
Which drug is most likely to be responsible for his diabetes of new onset?

A) simvastatin
B) mycophenolate mofetil
C) atenolol
D) tacrolimus
E) prednisolone

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

5. A 16-year-old girl presented with primary amenorrhoea. In early childhood she had undergone an inguinal herniorrhaphy. She had no other medical history of note. There was a family history of infertility affecting a maternal aunt.
On examination, she had adult breast development but no pubic or axillary hair. Examination was otherwise normal.
What test is most likely to aid diagnosis?

A) MR scan of pituitary and olfactory bulbs
B) blood karyotype
C) plasma gonadotropins
D) ultrasound scan of pelvis
E) ovarian antibody titres

Solutions: