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

1. A 69-year-old man with type 2 diabetes mellitus presented with a 3-day history of an ulcer on his right second toe.
On examination, the toe was red, swollen and enlarged, and looked like a 'sausage digit'. The ulcer appeared superficial.
Investigations:
X-ray of right second toeno sign of osteomyelitis
Cultures from the debrided wound bed were taken and the results were awaited.
What is the most appropriate type of antibiotic regimen to start empirically before the culture results are available?

A) narrow spectrum for 6 weeks
B) broad spectrum for 10 days
C) narrow spectrum for 10 days
D) broad spectrum for 6 weeks
E) no antibiotic

2. A 73-year-old man had been attending the diabetes clinic for 6 weeks with an ulcer on his right second metatarsal head. He had been receiving regular podiatry and offloading.
What new feature in the appearance of his foot is most likely to suggest the need to start antibiotics?

A) ulcer probing to bone
B) skin redness around ulcer
C) tracking sinus
D) pain around ulcer
E) increase in ulcer size

3. A 36-year-old man of South Asian origin presented acutely with a widespread pruritic rash involving the extensor surfaces of the limbs.
On examination, he was moderately obese with a body mass index of 33 kg/m2 (18-25), and the rash was erythematous, with multiple small papules with yellow centres.
Investigations:
fasting plasma glucose11.0 mmol/L (3.0-6.0)
haemoglobin A1c109 mmol/mol (20-42)
serum cholesterol8.0 mmol/L (<5.2)
serum HDL cholesterol0.80 mmol/L (>1.55)
fasting serum triglycerides31.00 mmol/L (0.45-1.69)
What is the most likely diagnosis?

A) tinea cutis
B) dermatitis herpetiformis
C) eruptive xanthoma
D) nodular prurigo
E) granuloma annulare

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

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

Solutions: