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

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

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

3. A 57-year-old man was admitted to hospital with joint pains. He was found to have gout. He had been found to have type 2 diabetes mellitus at the age of 47 years and developed nephropathy 7 years later. He was taking metformin 1 g twice daily, ramipril 5 mg twice daily and gliclazide 80 mg twice daily. The admitting team advised him to take ibuprofen 400 mg three times daily as needed.
On examination, his pulse was 87 beats per minute and his blood pressure was 146/85 mmHg. He had an inflamed right hallux.
Investigations:
serum sodium131 mmol/L (137-144)
serum potassium5.1 mmol/L (3.5-4.9)
serum creatinine156 umol/L (60-110)
estimated glomerular filtration rate (MDRD)42 mL/min/1.73 m2 (>60)
haemoglobin A1c72 mmol/mol (20-42)
random plasma glucose23.0 mmol/L
What is the most appropriate step in management?

A) stop gliclazide and ibuprofen
B) stop ibuprofen alone
C) withhold metformin alone
D) stop ibuprofen and withhold metformin
E) stop gliclazide and withhold metformin

4. A 48-year-old woman presented with a 2-year history of weight gain, easy bruising and
mood disturbance.
Investigations:
fasting plasma glucose6.9 mmol/L (3.0-6.0)
low-dose dexamethasone suppression test (2 mg/day for 48 h):
serum cortisol200 nmol/L (<50)
24-h urinary free cortisol (?3)670, 400 and 300 nmol (55-250)
plasma adrenocorticotropic hormone (09.00 h)25.0 pmol/L (3.3-15.4)
MR scan of pituitarynormal
What test is most likely to give a definitive diagnosis?

A) corticotropin-releasing hormone test
B) CT scan of chest
C) petrosal sinus sampling
D) high-dose dexamethasone suppression text (8 mg/day for 48 h)
E) octreotide scan

5. An 18-year-old man, whose ambition was to become a member of the elite armed forces, presented with gynaecomastia. His weekly alcohol consumption was 35 units.
On examination, he had normal secondary sexual characteristics, a well-developed, muscular physique and modest, slightly tender bilateral gynaecomastia. Testes were 10 mL with soft texture.
Investigations:
haemoglobin160 g/L (130-180)
MCV96 fL (80-96)
serum dehydroepiandrosterone sulphate4 umol/L (2-10)
serum oestradiol180 pmol/L (<180)
serum testosterone (09.00 h)6.0 nmol/L (9.0-35.0)
plasma follicle-stimulating hormone1.0 U/L (1.0-7.0)
plasma luteinising hormone0.7 U/L (1.0-10.0)
serum prolactin420 mU/L (<360)
What is the most likely diagnosis?

A) androgen abuse
B) alcohol excess
C) oestrogen-secreting testicular tumour
D) persistence of pubertal gynaecomastia
E) primary hypogonadotrophic hypogonadism

Solutions: