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

1. A 50-year-old Asian woman with an 18-year history of type 2 diabetes mellitus complained of discomfort and mild swelling in her left foot after tripping on a pavement. She was being treated with metformin, gliclazide and pioglitazone.
On examination, her foot was warm and slightly oedematous over the dorsum but not discoloured. She was afebrile and the foot pulses were bounding. Tendon reflexes in the legs were absent and vibration perception diminished. Urinalysis showed protein 2+, glucose 1+.
Investigations:
white cell count5.2 ? 109/L (4.0-11.0)
serum creatinine140 umol/L (60-110)
haemoglobin A1c63 mmol/mol (20-42)
X-ray of left footnormal bone architecture; some calcification of the arteries
isotope bone scanincreased isotope uptake in the mid-foot only
What is the most effective next step in management?

A) co-amoxiclav
B) below-knee removable walking boot
C) alendronic acid
D) celecoxib
E) immobilisation in a cast

2. A 67-year-old man underwent an isotope bone scan after being found to have a raised serum alkaline phosphatase (of bone origin). The blood test had been ordered because of mild lower back pain, which had now resolved. He was not taking any medication.
Examination was normal.
Investigations:
isotope bone scansee image

What is the most likely diagnosis?

A) osteomalacia
B) multiple myeloma
C) Paget's disease
D) fibrous dysplasia
E) prostate cancer

3. A 32-year-old woman presented to the outpatient clinic with a 1-year history of amenorrhoea that began after stopping her oral contraceptive pill. She had previously had two successful pregnancies and was otherwise well.
Examination was normal and no visual field defect was present on testing to confrontation.
Investigations:
serum sodium138 mmol/L (137-144) serum potassium3.8 mmol/L (3.5-4.9) plasma follicle-stimulating hormone2.0 U/L (2.5-10.0) plasma luteinising hormone2.0 U/L (2.5-10.0) serum prolactin1050 mU/L (<360)
MR scan of pituitarysee image

What is the most appropriate treatment?

A) bromocriptine
B) octreotide
C) pituitary surgery
D) stereotactic pituitary radiosurgery
E) cabergoline

4. A 55-year-old woman was referred with a 6-month history of type 2 diabetes mellitus. She was not taking any regular medication. She was a non-smoker. She drank 10 units of alcohol per week. Her general practitioner had arranged for her to see the community dietician as the patient had made significant changes to her diet.
On examination, she was obese with a body mass index of 31.8 kg/m2 (18-25). Her liver was not palpable.
Investigations:
serum ferritin310 ug/L (15-300)
serum total bilirubin16 umol/L (1-22)
serum alanine aminotransferase80 U/L (5-35)
serum aspartate aminotransferase75 U/L (1-31)
serum alkaline phosphatase150 U/L (45-105)
serum gamma glutamyl transferase35 U/L (4-35)
haemoglobin A1c67 mmol/mol (20-42)
serum cholesterol6.2 mmol/L (<5.2)
serum HDL cholesterol0.90 mmol/L (>1.55)
fasting serum triglycerides2.50 mmol/L (0.45-1.69)
What is the most appropriate management of her dyslipidaemia?

A) metformin
B) omega-3-acid ethyl esters
C) fenofibrate
D) simvastatin
E) ezetimibe

5. A 32-year-old woman presented at 34 weeks of pregnancy, after an episode of vaginal bleeding. Gestational diabetes had been diagnosed at 28 weeks and insulin was started at 29 weeks. Her pre-pregnancy body mass index was 32 kg/m2 (18-25) and there was no family history of diabetes. She was treated with betamethasone 12 mg over 2 days. She was taking 60 units of insulin subcutaneously daily (40 units prandial in three divided doses, and 20 units intermediate-acting insulin), which had been unchanged for 3 weeks.
On examination, she was apyrexial, her pulse was 96 beats per minute and her blood pressure was 124/74 mmHg. Urinalysis showed blood 1+, protein 1+, glucose 2+, ketones 3+.
Investigations:
serum sodium134 mmol/L (137-144)
serum potassium3.8 mmol/L (3.5-4.9)
serum chloride105 mmol/L (95-107) serum urea5.0 mmol/L (2.5-7.0) serum creatinine90 umol/L (60-110) random plasma glucose7.2 mmol/L
What is the most appropriate next step in management?

A) continue to monitor blood glucose in hospital
B) increase subcutaneous insulin doses by 2-4 units
C) discharge and monitor blood glucose at home
D) start intravenous insulin
E) measure venous bicarbonate

Solutions: