sce ed sample questions

7/29/2019 SCE ED Sample Questions

1/25

SCE E&D Sample Qs updated 01/12/11

Specialty Certificate Examination in Endocrinology and Diabetes Sample Questions

Question: 1

A 32-year-old Latin American woman had an oral glucose tolerance test in the 28th week

of pregnancy. Her fasting plasma glucose was 6.0 mmol/L (3.06.0) and 2-hour plasmaglucose was 11.3 mmol/L. Her current body mass index was 28 kg/m2. Weight gain in thepregnancy was 5 kg. There was no past history of gestational diabetes and no familyhistory of diabetes.

What is her approximate risk of developing type 2 diabetes mellitus by 5 yearspostpartum?

A 1%B 5%C 10%

D 40%E 90%


2/25


Question: 2

A 45-year-old man was referred with a 6-week history of polyuria, polydipsia and 7-kgweight loss. One week previously, his general practitioner had diagnosed type 2 diabetesmellitus and had started treatment with metformin. He had made appropriate changes to

his diet, but his fasting capillary blood glucose readings remained above 15 mmol/L (36).He was feeling tired but not otherwise unwell. He remained overweight with a body massindex of 34 kg/m2.

Investigations:

serum sodium 142 mmol/L (137144)serum potassium 4.9 mmol/L (3.54.9)serum bicarbonate 23 mmol/L (2028)serum creatinine 102 mol/L (60110)fasting plasma glucose 19.7 mmol/L (3.06.0)

urinalysis glycosuria 3+; ketonuria 2+

What is the most appropriate additional treatment?

A exenatideB gliclazideC intravenous insulin infusionD pioglitazoneE subcutaneous insulin


3/25


Question: 3

A 55-year-old woman had previously been found to have a 4-cm papillary thyroid cancer.She had been treated with surgery and radio-iodine and subsequently had anundetectable thyroglobulin but a high titre of anti-thyroglobulin antibody.

What is the most appropriate investigation at annual follow-up?

A CT scan of neckB PET scan of neckC serum anti-thyroid peroxidase antibodiesD ultrasound scan of neckE whole body iodine uptake scan


4/25


Question: 4

A 78-year-old woman was referred for bone density assessment after developing acutemid-thoracic bone pain. She had previously been found to have osteoporosis afterfracturing her right wrist after tripping in the street. She had also experienced two previous

episodes of severe back pain that were thought to have been caused by vertebralfractures. She had lost 12.5 cm in height. Her mother had developed a severe kyphosis inher seventies. She had been taking alendronic acid, calcium and vitamin D regularly for 3years.

On examination, there was a mild thoracic kyphosis and tenderness over the T10 vertebra.

Investigations:

erythrocyte sedimentation rate 35 mm/1st h (


5/25


Question: 5

A 43-year-old woman with a 2-year history of secondary amenorrhoea was seen in clinic atthe request of her general practitioner, following the finding of hyperprolactinaemia. Shehad a long-standing history of hypothyroidism treated with 100 g of thyroxine, anddepression treated with risperidone.

Investigations:

plasma prolactin 1800 mU/L (


6/25


Question: 6

A 77-year-old woman sustained a low trauma fracture of her right wrist. Two yearspreviously, she had fractured her proximal humerus.

Investigations for secondary causes of osteoporosis revealed no abnormalities.

Investigations:

DEXA scan result:T-score

L1L4 3.9L hip 2.7

What cell type in bone primarily senses strain and microdamage?

A adipocyteB lining cellC osteoblastD osteoclastE osteocyte


7/25


Question: 7

A 36-year-old man of European descent was reviewed in the diabetes clinic. He had type 2diabetes mellitus that had been diagnosed 6 months previously, He had been symptomfree and had no family history of cardiovascular disease but was a smoker.

On examination, his blood pressure was 138/76 mmHg, his weight was 90 kg and his bodymass index was 32 kg/m2.

Investigations:

urinary albumin:creatinine ratio 0.6 mg/mmol (


8/25


Question: 8

A 32-year-old woman presented to the outpatient department with a 1-year history ofamenorrhoea that began after stopping her oral contraceptive pill. She had experiencedtwo successful pregnancies and was otherwise well.

On examination, there was an upper outer quadrantanopia.

Investigations:

serum sodium 138 mmol/L (137144)serum potassium 3.8 mmol/L (3.54.9)

plasma follicle-stimulating hormone 2 U/L (2.510.0)plasma luteinising hormone 2 U/L (2.510.0)plasma prolactin 8450 mU/L (


9/25


Question: 9

A 26-year-old woman was admitted with diabetic ketoacidosis. After 24 hours of treatmentwith intravenous fluids, potassium and insulin, her normal subcutaneous insulin regimenwas resumed. However, she felt nauseated and there was a concomitant increase in urine

ketones (3+).

On examination, her pulse was 118 beats per minute and her blood pressure was106/66 mmHg.

Investigations:

serum sodium 136 mmol/L (137144)serum potassium 4.4 mmol/L (3.54.9)serum bicarbonate 15 mmol/L (2028)serum creatinine 78 mol/L (60110)

random plasma glucose 7.3 mmol/L

What is the most appropriate next step in management?

A increase subcutaneous basal insulin at bedtimeB increase subcutaneous bolus insulin with mealsC start glucose 5% with intravenous insulinD start glucose 10% with intravenous insulinE start intravenous insulin infusion with sliding scale


10/25


Question: 10

An 18-year-old woman was referred by her general practitioner for further investigation offunny turns during which she developed palpitations, sweating, tremor, hunger, anxietyand paraesthesiae; all of these symptoms were relieved immediately by a sugary drink.

She was otherwise well and was not taking any regular medication. There was a familyhistory of diabetes mellitus. A spontaneous hypoglycaemic episode had not been capturedand she was admitted to the diabetes/endocrine ward for a prolonged 72-hour fast. Herrenal function was normal.

After a 12-h fast she experienced her typical symptoms. Urinalysis showed no urinaryketones.

Investigations after 12-h fast:

fasting plasma glucose 2.0 mmol/L (3.06.0)

plasma insulin (after hypoglycaemia) 56 pmol/L (


11/25


Question 11

A 42-year-old woman was seen 6 weeks post partum. She had delivered a healthy babyweighing 3.9 kg at 38 weeks gestation and had begun breastfeeding, but she had recentlyfound that she was no longer able to breastfeed. She had a 4-year history of type 2

diabetes mellitus. She had been treated with methyldopa for hypertension during thepregnancy. Because of a misunderstanding, she had also restarted her pre-pregnancymedication 4 days before clinic review. Her medication comprised simvastatin 40 mg daily,metformin 500 mg three times a day, gliclazide 80 mg twice a day and enalapril 10 mgdaily.

Which of her medications is most likely to have interfered with lactation?

A enalaprilB gliclazideC metformin

D methyldopaE simvastatin


12/25


Question 12

A 65-year-old man with type 2 diabetes mellitus presented to the foot clinic with a painful,red, swollen foot. His body mass index was 34 kg/m2 (1825). An X-ray of the footdemonstrated neuroarthropathy (Charcots foot).

What is the most important reason for treatment with intravenous bisphosphonate?

A as an adjunct to surgery to improve the outcomeB to reduce deformity in the long termC to reduce painD to reduce the risk of contralateral Charcots footE to reduce the time to resolution


13/25


Question 13

A 30-year-old woman with type 2 diabetes mellitus reported that her younger brother hadrecently been found to have the same condition. Both her father and paternal grandfatherhad been treated with insulin. Her father had been found to have multiple kidney cysts on

ultrasound scan.

What gene mutation is most likely to be responsible for this pedigree?

A GCKB HNF1C HNF1D HNF4E KCNJ11


14/25


Question 14

A 64-year-old woman with a 20-year history of type 2 diabetes mellitus presented followingthe sudden onset of a painful right eye. She had noticed drooping of her right eyelid but nodouble vision. There were no other neurological symptoms.

On examination, there was a complete right-sided ptosis, with her eye position down andout. Her pupils were equal on both sides.

Investigations:

haemoglobin A1c 57 mmol/mol (2042)

MR scan of brain no evidence of any intracranialpathology

She was worried about her long-term prognosis and outcome.

What is the most likely prognosis?

A her condition is likely to deteriorate before it improvesB her prognosis is uncertain and depends upon metabolic controlC she is at risk of progression, and the other eye might also be affectedD she is likely to be left with a permanent ptosisE she is likely to make a very good recovery


15/25


Question 15

A 49-year-old woman presented with progressive loss of vision in both eyes. She wasotherwise well and her only medication was hormone replacement therapy.

Examination showed bitemporal hemianopia.

Investigations:

serum osmolality 296 mosmol/kg (278300)urinary osmolality 120 mosmol/kg (3501000)

serum cortisol (09.00 h) 456 nmol/L (200700)serum follicle-stimulating hormone 1.3 U/L (2.510.0)serum luteinising hormone 2.0 U/L (2.510.0)serum prolactin 1123 mU/L (


16/25


Question 16

A 35-year-old woman was referred with a left lower thyroid lesion. She was asymptomatic.

Examination confirmed the presence of a 2 3-cm, firm, mobile, non-tender mass.

Investigations:

fine-needle aspiration biopsy Thy 3

How is Thy 3 defined?

A abnormal; diagnostic of malignancyB abnormal; suspicious (but not diagnostic of) malignancyC follicular lesions

D non-diagnostic or inadequateE non-neoplastic (consistent with nodular goitre or thyroiditis)


17/25


Question 17

An 18-year-old man was referred with recently diagnosed hypertension. He had noprevious history of note and was taking no medication. His father had been found tohave hypertension in his twenties after sustaining a brain haemorrhage.

On examination, his blood pressure was raised at 190/110 mmHg.

Investigations:

serum sodium 142 mmol/L (137144)serum potassium 3.4 mmol/L (3.54.9)plasma renin activity (after 30 min supine) 0.2 pmol/mL/h (1.12.7)plasma aldosterone (after 30 min supine) 450 pmol/L (135400)

urinary 18-oxocortisol 32 nmol/mmol creatinine (0.86.5)

What is the most appropriate investigation?

A adrenal venous samplingB aldosterone suppression testC captopril testD CT scan of adrenal glandsE genetic testing


18/25


Question 18

A 24-year-old woman was admitted with confusion of 24 hours duration. She had beenfeverish with episodic vomiting for 48 hours. She had lost 10 kg in weight over the previous4 months, and had a poor appetite. She had become progressively fatigued and had been

made redundant from her cleaning job 7 weeks previously.

On examination, her pulse was 93 beats per minute and regular, and her blood pressurewas 93/64 mmHg. She was disorientated, with a Glasgow coma score of 11, but therewere no focal neurological signs. She was thin with a body mass index of 17 kg/m2 (1825). Examination was otherwise normal.

Investigations:

serum sodium 119 mmol/L (137144)serum potassium 5.0 mmol/L (3.54.9)

serum bicarbonate 18 mmol/L (2028)serum urea 9.7 mmol/L (2.57.0)serum creatinine 134 mol/L (60110)serum corrected calcium 3.20 mmol/L (2.202.60)fasting plasma glucose 3.3 mmol/L (3.06.0)serum cortisol (09.00 h) 192 nmol/L (200700)serum thyroid-stimulating hormone 8.3 mU/L (0.45.0)serum free T4 13.6 pmol/L (10.022.0)

What is the most appropriate intravenous therapy?

A aciclovirB disodium pamidronateC hydrocortisoneD metoclopramideE sodium chloride 0.9%


19/25


Question 19

A 35-year-old woman presented with a 6-month history of diffuse bone pain.Hypophosphataemic rickets had been diagnosed in childhood and she had been takingoral phosphate supplements since. She was currently taking two Phosphate-Sandoz

tablets four times per day.

On examination, a proximal myopathy was present.

Investigations:

serum creatinineBanked into FAIM 105 mol/L (60110)serum corrected calcium 2.35 mmol/L (2.202.60)serum phosphate 0.6 mmol/L (0.81.4)serum alkaline phosphatase 344 U/L (45105)plasma parathyroid hormone 9.5 pmol/L (0.95.4)

serum 25-OH-cholecalciferol 85 nmol/L (4590)

What is most appropriate treatment?

A add calcitriolB add cinacalcetC increase oral phosphateD intravenous phosphateE parathyroidectomy


20/25


Question 20

A 27-year-old woman presented 10 weeks into her first pregnancy with tremor, sweats,diarrhoea and no vomiting.

On examination, there was a fine tremor, her pulse was 110 beats per minute and regular,and her peripheries were hot and moist. She had a moderate diffuse goitre and there wasno thyroid-associated ophthalmopathy.

Investigations:

serum thyroid-stimulating hormone


21/25


Question 21

A 16-year-old girl was referred with primary amenorrhoea. She was otherwise healthy butreported significant weight gain over the past 2 years.

On examination, she had minor facial hirsutism and a blood pressure of 138/68 mmHg.Her body mass index was 29 kg/m2 (1825).

Investigations:

serum 17-hydroxyprogesterone 7 nmol/L (110)serum oestradiol 280 pmol/L (200400)serum testosterone 2.9 nmol/L (0.53.0)serum sex hormone binding protein 19 nmol/L (40137)

serum follicle-stimulating hormone 4.0 U/L (2.510.0)serum luteinising hormone 6.0 U/L (2.510.0)serum prolactin 600 mU/L (


22/25


Question 22

A 19-year-old woman presented to her general practitioner with secondary amenorrhoeaof 3 months duration. There was no history of weight loss or hirsutism and there had beenno previous menstrual disturbance. She was taking no medication and was otherwise well.

On examination, there was no galactorrhoea and no visual loss.

Investigations:

serum cortisol (09.00 h) 459 nmol/L (200700)serum oestradiol 1500 nmol/L (200400)serum testosterone 1.6 nmol/L (0.53.0)serum follicle-stimulating hormone


23/25


Question 23

A 48-year-old bus driver attended a diabetes clinic for review. He was taking metforminand gliclazide and had been intolerant of other oral medication. There were nocomplications of diabetes and he had never experienced hypoglycaemia.

He had held a Group 2 (vocational) driving licence for 5 years but had never informed theDriver and Vehicle Licensing Agency (DVLA) of his diabetes. He was advised to startinsulin.

What advice should be given about driving?

A he may be able to hold a Group 2 licence and can continue driving a bus but mustinform the DVLA as soon as possible

B he may be able to hold a Group 2 licence but should stop driving a bus immediatelyand inform the DVLA

C he may wish to inform the DVLA but does not need by law to do so unless he developscomplications of diabetes

D he will not be able to hold a Group 2 licence and must stop driving a bus immediatelyE he will not be able to hold a Group 2 licence but may apply to DVLA for an alternative

licence to allow him to continue driving a bus


24/25


Question 24

A 38-year-old woman presented with a goitre. It had been growing steadily for the past 4months. She described a 3-month history of worsening dysphagia and had experiencedchoking on lying down. She had unintentionally lost 3 kg in weight.

On examination, she was clinically euthyroid and had a large, smooth, non-tender goitrewith retrosternal extension.

Investigations:

serum thyroid-stimulating hormone 3.2 mU/L (0.45.0)serum free T4 19.8 pmol/L (10.022.0)serum anti-thyroid peroxidase antibodies 19.8 IU/mL (


25/25

Answers:

1. D

2. E

3. D

4. E

5. D

6. E

7. D

8. A

9. D

10. E

11. D

12. C

13. C

14. E

15. A

16. C

17. E

18. C

19. A

20. C

21. C

22. E

23. D

24. D

sce ed sample questions

Documents