European Board Examination in Endocrinology, Diabetes and Metabolism Sample Questions EBEEDM Sample Qus 2018 CERTS® Poolbook Pool - SCE E & D Sample Qus Item I27947.2 1. A 45-year-old man was referred with a 6- week history of polyuria, polydipsia and 7- kg weight loss. One week previously, his general practitioner had diagnosed type 2 diabetes mellitus and had started treatment with metformin. The patient had made appropriate changes to his diet, but his fasting plasma glucose readings remained above 15.0 mmol/L (3.0 –6.0). He was feeling tired but was otherwise well. On examination, he was overweight with a BMI of 34 .0 kg/m
2 (18.0–25.0). Urinalysis showed glucose 3+, ketones 2+. Investigations: serum sodium 142 mmol/L (137– 144) serum potassium 4.9 mmol/L (3.5 –4.9) serum bicarbonate 23 mmol/L (20– 28) serum creatinine 102 µmol/L (60–110) fasting plasma glucose 19.7 mmol/L (3.0– 6.0) What is the most appropriate additional treatment? A exenatide B gliclazide C intravenous insulin infusion D pioglitazone E subcutaneous insulin Comments Explanation: Patient has features consistent with type 1 diabetes, and insulin would be the most appropriate treatment . End of Item I27947.2 EBEEDM Sample Qus 2018 CERTS® Poolbook Pool - SCE E & D Sample Qus Item I27028.2 2. A 55-year-old woman had previously been found to have a 4- cm papillary thyroid cancer. She had been treated with surgery and radioiodine and subsequently had an undetectable thyroglobulin but a high titre of anti -thyroglobulin antibody. What is the most appropriate investigation at annual follow -up? A anti-thyroid peroxidase antibodies B CT scan of neck C PET scan of neck D ultrasound scan of neck E whole- body iodine uptake scan Comments Explanation: Ultrasound scan is the most sensitive investigation for the detection of locally recurrent papillary carcinoma, other investigations should be considered if ultrasound scan is negative or dis tant metastases are suspected. End of Item I27028.2 EBEEDM Sample Qus 2018 CERTS® Poolbook Pool - SCE E & D Sample Qus Item I27878.2 3. A 78-year-old woman was referred for bone density assessment after developing acute mid-thoracic bone pain. She had previously been found to have osteoporosis after fracturing 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 vertebral fractures. She had lost 12.5 cm in height. She had been taking alendronic acid and calcium and vitamin D tablets regularly for 3 years. Her mother had developed a severe kyphosis in her seventies. On examination, there was a mild thoracic kyphosis and tenderness over the patient’s T10 vertebra. Investigations: erythrocyte sedimentation rate 35 m m/1st h (<30) serum creatinine 105 µmol/L (60– 110) serum corrected calcium 2.35 mmol/L (2.20– 2.60) serum alkaline phosphatase 95 U/L (45– 105) X-ray of thorax and lumbar spine new crush fracture of T10; previously reported fractures of T8 and L1 DXA scan of spine (L2 –L4) T score – 3.8 DXA scan of total hip T score – 3.4 What is the most appropriate treatment? A continue alendronic acid B hormone replacement therapy C raloxifene D strontium ranelate E teriparatide Comments Explanation: Teriparatide is effective at reducing vertebral and non- vertebral fractures in post -
menopausal women, and reduces both pain and disabil ity due to spinal fractures . It is the most appropriate choice to control both the immediate symptoms and for long- term prevention. Teriparatide is the most effective drug in th is age group, particularly for spinal fractures . EBEEDM Sample Qus 2018
2 (18.0–25.0). Urinalysis showed glucose 3+, ketones 2+. Investigations: serum sodium 142 mmol/L (137– 144) serum potassium 4.9 mmol/L (3.5 –4.9) serum bicarbonate 23 mmol/L (20– 28) serum creatinine 102 µmol/L (60–110) fasting plasma glucose 19.7 mmol/L (3.0– 6.0) What is the most appropriate additional treatment? A exenatide B gliclazide C intravenous insulin infusion D pioglitazone E subcutaneous insulin Comments Explanation: Patient has features consistent with type 1 diabetes, and insulin would be the most appropriate treatment . End of Item I27947.2 EBEEDM Sample Qus 2018 CERTS® Poolbook Pool - SCE E & D Sample Qus Item I27028.2 2. A 55-year-old woman had previously been found to have a 4- cm papillary thyroid cancer. She had been treated with surgery and radioiodine and subsequently had an undetectable thyroglobulin but a high titre of anti -thyroglobulin antibody. What is the most appropriate investigation at annual follow -up? A anti-thyroid peroxidase antibodies B CT scan of neck C PET scan of neck D ultrasound scan of neck E whole- body iodine uptake scan Comments Explanation: Ultrasound scan is the most sensitive investigation for the detection of locally recurrent papillary carcinoma, other investigations should be considered if ultrasound scan is negative or dis tant metastases are suspected. End of Item I27028.2 EBEEDM Sample Qus 2018 CERTS® Poolbook Pool - SCE E & D Sample Qus Item I27878.2 3. A 78-year-old woman was referred for bone density assessment after developing acute mid-thoracic bone pain. She had previously been found to have osteoporosis after fracturing 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 vertebral fractures. She had lost 12.5 cm in height. She had been taking alendronic acid and calcium and vitamin D tablets regularly for 3 years. Her mother had developed a severe kyphosis in her seventies. On examination, there was a mild thoracic kyphosis and tenderness over the patient’s T10 vertebra. Investigations: erythrocyte sedimentation rate 35 m m/1st h (<30) serum creatinine 105 µmol/L (60– 110) serum corrected calcium 2.35 mmol/L (2.20– 2.60) serum alkaline phosphatase 95 U/L (45– 105) X-ray of thorax and lumbar spine new crush fracture of T10; previously reported fractures of T8 and L1 DXA scan of spine (L2 –L4) T score – 3.8 DXA scan of total hip T score – 3.4 What is the most appropriate treatment? A continue alendronic acid B hormone replacement therapy C raloxifene D strontium ranelate E teriparatide Comments Explanation: Teriparatide is effective at reducing vertebral and non- vertebral fractures in post -
menopausal women, and reduces both pain and disabil ity due to spinal fractures . It is the most appropriate choice to control both the immediate symptoms and for long- term prevention. Teriparatide is the most effective drug in th is age group, particularly for spinal fractures . EBEEDM Sample Qus 2018
