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

1. A 59-year-old man with an 8-year history of type 2 diabetes mellitus was seen in the outpatient clinic. He had worsening renal function in the absence of microalbuminuria.
On examination, his blood pressure was 175/90 mmHg. He had a femoral bruit, and absent dorsalis pedis pulses bilaterally.
Investigations:
serum creatinine150 umol/L (60-110)
estimated glomerular filtration rate (MDRD)39 mL/min/1.73m2 (>60)
In addition to addressing his blood pressure, what is the most appropriate next investigation?

A) captopril diethylene triamine pentacaetic acid (DTPA) scan
B) mercaptoacetyltriglycine (MAG3) renography
C) lower limb angiography
D) renal ultrasound scan with Doppler studies
E) MR angiography of renal arteries

2. A 72-year-old man with a 12-year history of type 2 diabetes mellitus was found to have carcinoma of the bladder. He was taking metformin; however, this was stopped because of his deteriorating renal function.
On examination, his weight was 95 kg and his body mass index was 32 kg/m2 (18-25).
Investigations:
serum sodium143 mmol/L (137-144)
serum potassium4.4 mmol/L (3.5-4.9)
serum creatinine175 umol/L (60-110)
estimated glomerular filtration rate (MDRD)27 mL/min/1.73 m2 (>60)
haemoglobin A1c64 mmol/mol (20-42)
What is the most appropriate addition to his medication?

A) pioglitazone
B) gliclazide
C) liraglutide
D) sitagliptin
E) dapagliflozin

3. A 17-year-old boy with type 1 diabetes mellitus was admitted with diabetic ketoacidosis
precipitated by a recent viral illness.
Investigations on admission:
random plasma glucose15.0 mmol/L
arterial blood gases, breathing air:
pH7.07 (7.35-7.45)
H+85 nmol/L (35-45)
Investigations after initial treatment with fluids, insulin and potassium 7 h after admission:
random plasma glucose4.0 mmol/L
serum bicarbonate10 mmol/L (20-28)
At this stage, he was being given infusions of insulin (1 U/h) and glucose 5% (100 mL/h).
What is the most appropriate next step in management?

A) stop insulin infusion if glucose falls any further, then repeat plasma glucose in 15 min
B) continue current regimen but encourage oral carbohydrate intake
C) continue current regimen
D) give intravenous sodium bicarbonate
E) continue insulin infusion and change glucose to a higher concentration

4. A 28-year-old man presented to his optician with a 6-month history of gradually deteriorating vision. He was found to have a visual field defect and was referred urgently to an ophthalmologist who confirmed the finding, and arranged the following investigations.
Investigations (at 09.00 h):
serum cortisol300 nmol/L (200-700) serum testosterone6.5 nmol/L (9.0-35.0) plasma follicle-stimulating hormone1.2 U/L (1.0-7.0) plasma luteinising hormone1.3 U/L (1.0-10.0) serum thyroid-stimulating hormone2.4 mU/L (0.4-5.0) serum free T411.1 pmol/L (10.0-22.0)
What is the most important next investigation?

A) short tetracosactide (Synacthen@) test
B) adrenocorticotropic hormone
C) prolactin
D) random growth hormone
E) insulin stress test

5. A 16-year-old boy was referred to the endocrine clinic. He was concerned about his growth and pubertal development. He was well with no significant medical history. He had felt his development had lagged behind his peers for the previous 2 years and he had been the shortest in his class for some time and was being bullied.
General examination was normal. His height was 1.53 m and weight 52.4 kg. He had Tanner stage 3 genitalia and pubic hair. Axillary hair was present. Testicular volumes were 6 mL bilaterally.
Investigations:
serum testosterone4.4 nmol/L (9.0-35.0)
plasma follicle-stimulating hormone2.5 U/L (1.0-7.0)
plasma luteinising hormone1.8 U/L (1.0-10.0)
serum insulin-like growth factor 134.5 nmol/L (9.3-56.0)
insulin tolerance test:

What is the most appropriate treatment?

A) testosterone 50 mg intramuscularly per month
B) reassure and review
C) growth hormone 0.4 mg subcutaneously per day
D) hydrocortisone 15 mg am, 5 mg pm
E) testosterone 250 mg intramuscularly per month

Solutions: