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

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

2. A 26-year-old woman was recovering from diabetic ketoacidosis and had been switched to her usual basal bolus insulin regimen. Her capillary blood glucose measurements during the day were high but fasting plasma glucose was in the range 5.0-7.0 mmol/L (3.0-6.0). She was drinking and eating normally.
On examination, her pulse was 76 beats per minute and her blood pressure was 106/66 mmHg. Urinalysis showed ketones 1+.
Investigations:
serum sodium143 mmol/L (137-144)
serum potassium4.4 mmol/L (3.5-4.9)
serum bicarbonate22 mmol/L (20-28)
serum creatinine72 umol/L (60-110)
plasma glucose 2 h after breakfast21 mmol/L
What is the most appropriate next step in management?

A) start variable-rate intravenous insulin infusion
B) increase bolus insulin with meal
C) start glucose 5% with intravenous insulin
D) increase basal insulin at bed time
E) change to twice daily pre-mixed insulin

3. A 61-year-old woman was found incidentally to have a raised serum calcium concentration. She was otherwise well. Her father had undergone a neck operation many years previously.
Investigations:
serum corrected calcium2.78 mmol/L (2.20-2.60)
plasma parathyroid hormone10.8 pmol/L (0.9-5.4)
Her general practitioner thought she had primary hyperparathyroidism.
Which further finding is most likely to cast doubt upon this diagnosis?

A) low serum magnesium concentration
B) normal parathyroid radioisotope scan (sestamibi scan)
C) high serum 25-OH-cholecalciferol
D) low urinary calcium excretion
E) normal serum phosphate concentration

4. A 44-year-old man was referred for investigation of cortisol excess. He had poorly controlled hypertension, and a long history of type 2 diabetes mellitus with retinopathy and peripheral neuropathy. His medication comprised aspirin, ramipril, atenolol, carbamazepine, metformin and simvastatin.
Initial investigations:
serum cortisol (09.00 h)350 nmol/L (200-700)
serum cortisol (22.00 h)48 nmol/L (50-250)
overnight dexamethasone suppression test (after 1 mg dexamethasone):
serum cortisol93 nmol/L (<50)
24-h urinary free cortisol (day 1)225 nmol (55-250)
24-h urinary free cortisol (day 2)200 nmol (55-250)
24-h urinary free cortisol (day 3)185 nmol (55-250)
What is the most appropriate next step in management?

A) reassure and discharge
B) high-dose 48-h dexamethasone suppression test
C) MR scan of pituitary
D) CT scan of adrenal glands
E) dexamethasone-suppressed corticotrophin-releasing hormone test

5. A pregnant 36-year-old woman presented to the diabetes outpatient clinic. She had type 2
diabetes mellitus treated with diet, lifestyle changes and metformin 500 mg twice daily.
On examination, her blood pressure was 128/84 mmHg.
Investigations:
haemoglobin A1c47 mmol/mol (20-42)
urinary albumin:creatinine ratio1.6 mg/mmol (<3.5)
Which is the best agent to reduce the risk of pre-eclampsia in this patient?

A) omega-3-marine triglycerides
B) insulin
C) aspirin
D) labetalol
E) folic acid

Solutions: