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

1. A 36-year-old man of African origin attended the clinic 2 weeks after discharge from hospital following his first admission with diabetic ketoacidosis. He had made a rapid recovery and had been discharged taking subcutaneous insulin twice daily.
At clinic, he reported home blood glucose measurements of 4-6mmol/L, occasional symptomatichypoglycaemia and a total daily insulin dose of 12 units. He asked if his glucose-lowering treatment should change.
Which test is most likely to predict prolonged insulin independence?

A) anti-glutamic acid decarboxylase antibodies
B) glucagon-stimulated C-peptide concentration
C) anti-islet cell antibodies
D) fasting C-peptide concentration
E) genotyping for monogenic diabetes

2. A 55-year-old woman presented with a 3-week history of nausea and vomiting. Her only medical complaints were frequent dyspepsia, for which she was taking indigestion tablets, and asthma for which she was taking a salbutamol inhaler as required.
On examination, there was no evidence of lymphadenopathy, her chest was clear on auscultation and abdominal examination was normal.
Investigations (before and after taking omeprazole for 3 weeks):
beforeafternormal erythrocyte sedimentation rate (mm/1st h)44<30 serum creatinine (umol/L)17011060-110 serum corrected calcium (mmol/L)2.852.402.20-2.60
serum phosphate (mmol/L)1.90.8-1.4
serum angiotensin-converting enzyme (U/L)8525-82
plasma parathyroid hormone (pmol/L)0.44.40.9-5.4
What is the most likely cause of the hypercalcaemia?

A) parathyroid hormone-related peptide-secreting malignancy
B) sarcoidosis
C) multiple myeloma
D) milk-alkali syndrome
E) primary hyperparathyroidism

3. 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

4. An 85-year-old woman was referred with a lump in her neck. She had no symptoms of thyroid disease.
On examination, she had a 2 ? 3-cm firm mass at the lower pole in the right thyroid lobe. Her resting pulse was 90 beats per minute and regular.
Investigations:
serum thyroid-stimulating hormone3.5 mU/L (0.4-5.0)
serum free T415.0 pmol/L (10.0-22.0)
serum free T36.2 pmol/L (3.0-7.0)
anti-thyroid peroxidase antibodies28 IU/mL (<50) ultrasound scan of thyroidmixed cystic/solid mass with scattered microcalcifications
fine-needle aspiration biopsyThy 3a
What is the most appropriate next step in her management?

A) subtotal thyroidectomy
B) PET scan of thyroid
C) repeat fine-needle aspiration
D) CT scan of neck
E) ablative radioiodine treatment

5. A 69-year-old man with type 2 diabetes mellitus presented with a 3-day history of an ulcer on his right second toe.
On examination, the toe was red, swollen and enlarged, and looked like a 'sausage digit'. The ulcer appeared superficial.
Investigations:
X-ray of right second toeno sign of osteomyelitis
Cultures from the debrided wound bed were taken and the results were awaited.
What is the most appropriate type of antibiotic regimen to start empirically before the culture results are available?

A) no antibiotic
B) narrow spectrum for 6 weeks
C) narrow spectrum for 10 days
D) broad spectrum for 10 days
E) broad spectrum for 6 weeks

Solutions: