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

1. A 56-year-old man presented with a 6-month history of erectile dysfunction. He had noticed a gradual reduction in his frequency of shaving from daily to twice a week. His libido had diminished and he felt that he was not as strong as he once was. He also described general aches and pains. He was a farm worker and had drunk a bottle of vodka daily for several years, but had stopped drinking 2 years previously. He was a non-smoker.
Investigations:
serum urea6.2 mmol/L (2.5-7.0)
serum creatinine89 umol/L (60-110)
serum albumin40 g/L (37-49)
serum total bilirubin17 umol/L (1-22) serum alanine aminotransferase48 U/L (5-35) serum aspartate aminotransferase37 U/L (1-31) haemoglobin A1c55 mmol/mol (20-42)
serum cortisol (09.00 h)389 nmol/L (200-700) serum testosterone0.7 nmol/L (9.0-35.0) plasma follicle-stimulating hormone2.1 U/L (1.0-7.0) plasma luteinising hormone2.4 U/L (1.0-10.0) serum prolactin458 mU/L (<360) serum thyroid-stimulating hormone3.4 mU/L (0.4-5.0)
MR scan of pituitarysee image

What is the most likely explanation of his symptoms?

A) haemochromatosis
B) age-related hypogonadism
C) pituitary adenoma
D) hyperprolactinaemia
E) cirrhosis of liver

2. A 71-year-old man was brought to the emergency department in a collapsed state. He was
unable to give a history. Records showed that he had ischaemic heart disease and had undergone coronary bypass grafting 2 years previously. He was taking bendroflumethiazide 2.5 mg daily and simvastatin 40 mg at bedtime.
On examination he was unwell. His pulse was 128 beats per minute and his blood pressure was 108/60 mmHg. Oxygen saturation was 96% (94-98) breathing air.
An ECG showed Q waves in leads II, III, and aVF.
Investigations:
serum sodium164 mmol/L (137-144)
serum potassium5.4 mmol/L (3.5-4.9)
serum bicarbonate19 mmol/L (20-28)
serum urea15.2 mmol/L (2.5-7.0)
serum creatinine145 umol/L (60-110)
random plasma glucose81.2 mmol/L
What is the most appropriate fluid replacement?

A) sodium chloride 0.9%
B) sodium chloride 0.9% and glucose 5%
C) sodium chloride 0.45%
D) compound sodium lactate intravenous infusion
E) colloid

3. A 33-year-old woman presented with tiredness, palpitations, weight loss and emotional
lability 9 weeks after the birth of her third child.
On examination, she had a sinus tachycardia, a fine tremor, slight lid retraction and a mild
diffuse non-tender goitre.
Investigations:
serum thyroid-stimulating hormone<0.01 mU/L (0.4-5.0)
serum free T434.3 pmol/L (10.0-22.0)
technetium-99m scan of thyroid (20-min uptake)<1% (0.4-3.0)
What is the most appropriate treatment?

A) propranolol
B) aqueous iodine oral solution
C) carbimazole
D) potassium perchlorate
E) propylthiouracil

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

5. A 50-year-old man with a 9-year history of type 2 diabetes mellitus presented with excessive tiredness. His partner said that he snored excessively. His haemoglobin A1c was usually between 64 and 75 mmol/mol (20-42). He was taking glimepiride 4 mg daily and orlistat. He was intolerant of metformin.
On examination, he had reduced sensation to a 10-g monofilament, and extensive background diabetic retinal changes. His Epworth sleepiness score was 13/24. His body mass index was 36 kg/m2 (18-25) despite compliance with orlistat.
According to the NICE guidelines (CG87, May 2009), what is the most appropriate treatment?

A) dipeptidyl peptidase-4 inhibitor
B) glucagon-like peptide-1 agonist
C) basal bolus insulin
D) acarbose
E) bariatric surgery

Solutions: