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

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

2. A 15-year-old boy was referred by the school nurse because she was concerned about his weight. There was no past history of note. He was not taking any medication. His height was 1.61 m and he weighed 70.5 kg.
Investigations: growth chartsee image

What is the most likely diagnosis?

A) leptin deficiency
B) simple obesity
C) Cushing's disease
D) Prader-Willi syndrome
E) growth hormone deficiency

3. A 29-year-old woman presented with primary infertility, having had unprotected sexual intercourse for 15 months. Menarche had occurred at the age of 13.5 years. Her menstrual cycle was irregular, occurring every 20-60 days. There was no history of galactorrhoea. She denied abnormal hair growth.
On examination, her body mass index was 28.9 kg/m2 (18-25) and she had normal secondary sexual characteristics. Her visual fields were full to confrontation.
Investigations:
serum androstenedione12.8 nmol/L (0.6-8.8)
serum oestradiol205 pmol/L (200-400)
serum testosterone2.4 nmol/L (0.5-3.0)
serum sex hormone binding globulin23 nmol/L (40-137)
serum follicle-stimulating hormone4.3 U/L (2.5-10.0)
serum luteinising hormone8.5 U/L (2.5-10.0)
serum prolactin420 mU/L (<360)
hysterosalpingogrampatent fallopian tubes
partner's semen analysisnormal sperm count and motility
What is the most appropriate first-line intervention?

A) cabergoline
B) human chorionic gonadotropin
C) metformin
D) orlistat
E) human menopausal gonadotropins

4. A 53-year-old man with a history of sweats and tremor was found to have abnormal thyroid function tests and a small diffuse goitre. He was treated with carbimazole 20 mg but developed a sore throat after 3 weeks.
Investigations:
haemoglobin150 g/L (130-180)
white cell count2.0 ? 109/L (4.0-11.0)
neutrophil count0.4 ? 109/L (1.5-7.0)
serum thyroid-stimulating hormone<0.02 mU/L (0.4-5.0)
serum free T429.0 pmol/L (10.0-22.0)
thyrotropin receptor antibodiespositive
The carbimazole was stopped; his sore throat resolved and the full blood count normalised.
What is the most appropriate next step in management?

A) start propylthiouracil 100 mg twice daily
B) treat with Lugol's iodine 5 drops three times daily for 6 months
C) early partial thyroidectomy
D) early radioactive iodine therapy
E) restart carbimazole 5 mg daily

5. A 55-year-old woman presented with thirst, polyuria and polydipsia. Her symptoms had started 9 months previously following a road traffic accident. Her past medical history was normal and she was not taking any regular medication.
On examination, her blood pressure was 130/80 mmHg with no postural drop. Urine volume measured 5 L in 24 hours.
Investigations:
serum sodium131 mmol/L (137-144) serum potassium3.6 mmol/L (3.5-4.9) serum urea2.0 mmol/L (2.5-7.0) serum corrected calcium2.40 mmol/L (2.20-2.60) fasting plasma glucose6.4 mmol/L (3.0-6.0) serum osmolality278 mosmol/kg (278-300) urinary osmolality100 mosmol/kg (100-1000)
What is the most likely diagnosis?

A) nephrogenic diabetes insipidus
B) syndrome of inappropriate antidiuretic hormone
C) primary polydipsia
D) diabetes mellitus
E) cranial diabetes insipidus

Solutions: