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

1. A 77-year-old woman presented with a 10-week history of facial hirsutism, scalp hair loss and deepening of the voice.
On examination, her body mass index was 32 kg/m2 (18-25). Her blood pressure was 164/94 mmHg. She had coarse terminal hairs on her upper lip and beard areas. Abdominal examination was normal, but she refused examination of her external genitalia.
Investigations:
serum sodium144 mmol/L (137-144) serum potassium3.6 mmol/L (3.5-4.9) serum urea7.7 mmol/L (2.5-7.0) serum creatinine122 umol/L (60-110) fasting plasma glucose6.4 mmol/L (3.0-6.0) serum testosterone17.2 nmol/L (0.5-3.0) serum luteinising hormone2.2 U/L (>30.0)
What is the most appropriate initial investigation?

A) serum dehydroepiandrosterone sulphate
B) serum oestradiol
C) plasma adrenocorticotropic hormone and serum cortisol
D) overnight dexamethasone suppression test (after 1 mg dexamethasone)
E) CT scan of abdomen and pelvis

2. A 36-year-old woman was seen in the clinic with a recurrence of hyperthyroidism after a 2year remission. She had been treated with carbimazole for 18 months following her original presentation. She was moderately symptomatic and was keen to be treated in the same way again. She was planning a pregnancy.
Investigations: serum prolactin240 mU/L (<360) serum thyroid-stimulating hormone<0.1 mU/L (0.4-5.0) serum free T428.0 pmol/L (10.0-22.0)
anti-thyroid-stimulating hormone receptor antibodies44 U/L (<7)
What is the most appropriate next step in management?

A) carbimazole
B) radioiodine treatment
C) block-and-replace treatment with carbimazole and levothyroxine
D) referral for thyroidectomy
E) propylthiouracil

3. A 54-year-old man was referred to the diabetes foot clinic with a plantar foot ulcer of 3 months' duration under the right first metatarsal head. He had a 10-year history of type 2 diabetes mellitus. He lived alone and had to do his own shopping and cleaning.
On examination, the ulcer was 3 ? 2 cm in area, 4 mm in depth, and had a clean granulating base. He had strong palpable pedal pulses and sensory neuropathy in both feet.
What is the most effective intervention to heal this ulcer?

A) Manuka honey-impregnated wound dressing
B) ambulatory vacuum-assisted pump therapy
C) removable pressure-relieving boot
D) long-term oral antibiotics
E) total contact casting

4. 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 0.45%
C) compound sodium lactate intravenous infusion
D) colloid
E) sodium chloride 0.9% and glucose 5%

5. A 46-year-old man of European descent was reviewed in the diabetes clinic. He had type 2 diabetes mellitus, which had been diagnosed 6 months previously. He had been symptom free and was a non-smoker but had a family history of cardiovascular disease. He exercised regularly and had managed to lose 8 kg.
On examination, his blood pressure was 148/76 mmHg, his weight was 76 kg and his body mass index was 24 kg/m2 (18-25).
Investigations:
urinary albumin:creatinine ratio0.6 mg/mmol (<2.5)
serum cholesterol5.6 mmol/L (<5.2)
serum HDL cholesterol0.90 mmol/L (>1.55)
fasting serum triglycerides2.20 mmol/L (0.45-1.69)
According to NICE guidelines (CG181, July 2014), what is the most appropriate management of his lipid profile?

A) start nicotinic acid
B) start a statin
C) observe and repeat lipid profile in a few months
D) start a fibrate
E) assess cardiovascular risk using UKPDS risk engine

Solutions: