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

1. A 25-year-old woman with type 1 diabetes mellitus presented with light-headedness, nausea, thirst and vomiting of 3 days' duration. She was fully conscious.
On examination, her pulse was 104 beats per minute and her blood pressure was 104/64 mmHg. Urinalysis showed glucose 2+, ketones 3+.
Investigations:
serum sodium150 mmol/L (137-144)
serum potassium5.5 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 glucose20.0 mmol/L
arterial blood gases, breathing air:
PO212.4 kPa (11.3-12.6)
PCO23.4 kPa (4.7-6.0)
pH7.15 (7.35-7.45)
H+70 nmol/L (35-45)
bicarbonate6 mmol/L (21-29)
What intravenous fluid should be given over the first 30 minutes?

A) sodium chloride 0.9%
B) sodium chloride 0.18% and glucose 4%
C) sodium chloride 0.45%
D) colloid solution
E) compound sodium lactate

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

3. A 28-year-old man was seen in the lipid clinic following a referral from the general surgical team. He had had two episodes of acute pancreatitis over the preceding 6 months, which settled spontaneously. He had a past medical history of HIV disease and was taking highly active antiretroviral (HAART) therapy. He drank 12 units of alcohol per week.
On examination, he had no stigmata of hyperlipidaemia.
Investigations:
fasting plasma glucose6.2 mmol/L (3.0-6.0)
haemoglobin A1c44 mmol/mol (20-42)
serum cholesterol7.5 mmol/L (<5.2)
fasting serum triglycerides23.70 mmol/L (0.45-1.69)
serum thyroid-stimulating hormone0.7 mU/L (0.4-5.0)
serum free T414.3 pmol/L (10.0-22.0)
What class of antiretroviral drug is the most likely cause of his metabolic disturbance?

A) non-nucleoside reverse transcriptase inhibitors (e.g. nevirapine)
B) protease inhibitors (e.g. ritonavir)
C) integrase inhibitors (e.g. raltegravir)
D) nucleoside reverse transcriptase inhibitors (e.g. zidovudine)
E) entry inhibitors (e.g. enfuvirtide)

4. A 56-year-old man was referred to the diabetes clinic for conversion to insulin. He was taking metformin 1 g three times daily, gliclazide 160 mg twice daily and pioglitazone 45 mg daily. He drank no alcohol.
On examination, his body mass index was 41 kg/m2 (18-25). Abdominal examination showed a 2-cm, smooth, non-tender liver edge.
Which liver function test is the best marker of non-alcoholic fatty liver disease in type 2 diabetes mellitus?

A) alanine aminotransferase
B) alkaline phosphatase
C) bilirubin
D) aspartate aminotransferase
E) gamma glutamyl transferase

5. A 17-year-old boy, with short stature, obesity and neurobehavioural problems, was referred because of cold intolerance.
On examination, he and his mother had similar body habitus and short fingers (brachydactyly).
Investigations (before attending clinic):
serum sodium143 mmol/L (137-144) serum potassium4.4 mmol/L (3.5-4.9) serum creatinine93 umol/L (60-110) serum corrected calcium2.02 mmol/L (2.20-2.60) serum phosphate1.7 mmol/L (0.8-1.4)
serum thyroid-stimulating hormone16.0 mU/L (0.4-5.0) serum free T410.0 pmol/L (10.0-22.0) plasma parathyroid hormone27.0 pmol/L (0.9-5.4)
His mother's blood tests were all normal.
What is the most likely diagnosis in this boy?

A) pseudohypoparathyroidism
B) polyglandular autoimmune syndrome type 1
C) pseudopseudohypoparathyroidism
D) DiGeorge syndrome
E) McCune-Albright syndrome

Solutions: