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

2. A 42-year-old woman presented with a 6-month history of tiredness. She also had a history of hypothyroidism, for which she was taking levothyroxine 150 micrograms daily, and a family history of hyperactivity syndrome.
Examination was normal.
Investigations:
serum thyroid-stimulating hormone12.3 mU/L (0.4-5.0)
serum free T418.0 pmol/L (10.0-22.0)
What is the most likely diagnosis?

A) thyroid hormone resistance
B) pituitary thyrotroph adenoma
C) non-adherence with thyroid hormone treatment
D) levothyroxine malabsorption
E) suboptimal prescribed dose of levothyroxine

3. A 56-year-old woman was referred for assessment of asymptomatic hypercalcaemia.
Investigations:
serum corrected calcium2.73 mmol/L (2.20-2.60)
plasma parathyroid hormone8.9 pmol/L (0.9-5.4)
urinary calcium:creatinine clearance ratio0.002
An X-ray of abdomen was normal and imaging of her neck showed no evidence of a
parathyroid adenoma.
What is the pattern of inheritance of this condition?

A) autosomal dominant
B) mitochondrial
C) autosomal recessive
D) X-linked dominant
E) X-linked recessive

4. A 17-year-old boy with a 10-year history of type 1 diabetes mellitus was admitted with diabetic ketoacidosis after a night of binge drinking.
He was treated appropriately with a fixed-rate intravenous insulin infusion and intravenous sodium chloride 0.9%.
Twenty-four hours after admission, he was eating and drinking normally. He was taking his usual doses of subcutaneous insulin and his urinary ketones were undetectable.
Investigations (6 hours previously):
venous blood gases, breathing air: PO25.6 kPa PCO23.8 kPa pH7.29 bicarbonate16 mmol/L base excess-1 mmol/L
lactate1.1 mmol/L
What is the likely most cause of these results?

A) concurrent aspirin ingestion
B) continued ketonaemia
C) hyperchloraemia
D) hyporeninaemic hypoaldosteronism
E) alcohol toxicity

5. A 54-year-old woman attended clinic for routine follow-up. She had Cushing's syndrome secondary to ectopic adrenocorticotropic hormone syndrome with no primary source identified.
She had declined bilateral adrenalectomy. Routine medication included metyrapone 500 mg three times daily, ketoconazole 200 mg once daily and hydrocortisone 10 mg in the morning and 5 mg in the evening.
Metyrapone inhibits the action of which enzyme in steroidogenesis?

A) 3?-hydroxysteroid dehydrogenase
B) 5?-reductase
C) 21-hydroxylase
D) 11?-hydroxylase
E) 17?-hydroxylase

Solutions: