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

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

2. A 48-year-old man presented with an infected ulcer, measuring 2 ? 1 cm, over the right first metatarsal head, with surrounding cellulitis. He had no previous history of diabetes mellitus but had been told by his general practitioner some years previously that his blood glucose was 'borderline'.
On examination, his temperature was 37.4C, his blood pressure was 158/92 mmHg and his body mass index was 31.5 kg/m2 (18-25). His foot pulses were easily palpable but he had a sensory neuropathy.
Investigations:
random plasma glucose16.4 mmol/L
haemoglobin A1c81 mmol/mol (20-42)
What is the most appropriate treatment for his hyperglycaemia?

A) gliclazide 40 mg twice daily
B) soluble insulin before meals, basal insulin at bedtime
C) sitagliptin 100 mg once daily
D) exenatide 5 micrograms twice daily
E) metformin 500 mg twice daily

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

4. A 56-year-old woman presented with a swelling in her neck, which she had noticed by chance 6 weeks previously. The swelling had not changed in size since she first noticed it, and was completely asymptomatic.
On examination, there was a smooth nodule in the thyroid that moved up on swallowing and there was no lymphadenopathy.
Investigations:
ultrasound scan of thyroidsingle 4.7-cm hypoechoic nodule
in upper left lobe
serum thyroid-stimulating hormone0.8 mU/L (0.4-5.0)
What is the most appropriate next step in management?

A) FDG-PET CT scan
B) fine-needle aspiration for cytology
C) serial ultrasound examinations
D) isotope uptake scan
E) hemithyroidectomy

5. A 27-year-old woman presented with oligomenorrhoea and hirsutism, and a 2-year history of infertility. Her body mass index was 26 kg/m2 (18-25). Her partner had a recent normal sperm count and motility test.
Investigations:
serum androstenedione17.0 nmol/L (0.6-8.8)
serum 17-hydroxyprogesterone2 nmol/L (1-10)
serum testosterone2.8 nmol/L (0.5-3.0)
serum sex hormone binding globulin18 nmol/L (40-137)
serum follicle-stimulating hormone2.3 U/L (2.5-10.0)
serum luteinising hormone8.3 U/L (2.5-10.0)
serum prolactin152 mU/L (<360)
A diagnosis of polycystic ovary syndrome was made.
What is the most effective next step to help her conceive?

A) metformin
B) orlistat
C) diet and exercise
D) clomifene
E) in vitro fertilisation

Solutions:

Question # 1 Answer: A

Question # 2 Answer: E

Question # 3 Answer: A

Question # 4 Answer: B

Question # 5 Answer: D