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

1. A 42-year-old woman, with type 1 diabetes mellitus of 22 years' duration, attended for annual review. She was using biphasic insulin twice daily and taking aspirin 75 mg, simvastatin 40 mg and ramipril 10 mg daily.
On examination, her blood pressure was 164/87 mmHg.
Investigations:
serum potassium5.9 mmol/L (3.5-4.9)
serum creatinine197 umol/L (60-110)
estimated glomerular filtration rate (MDRD)26 mL/min/1.73 m2 (>60)
haemoglobin A1c72 mmol/mol (20-42)
urinary albumin:creatinine ratio27.0 mg/mmol (<3.5)
urine culturenegative
What is the most important next step in management?

A) add aliskiren
B) check bicarbonate
C) change to intensive insulin regimen
D) refer to a nephrologist
E) add furosemide

2. A 54-year-old woman was referred for assessment of low bone mineral density. Three months previously, after complaining of bloating and flatulence, she had been found to have coeliac disease and had been started on a gluten-free diet. She had no history of fracture and had not lost height. There was no family history of osteoporosis. Her only medication was omeprazole.
Investigations:
serum corrected calcium2.42 mmol/L (2.20-2.60) serum alkaline phosphatase122 U/L (45-105)
plasma parathyroid hormone7.9 pmol/L (0.9-5.4)
DXA scansee image What is the most appropriate treatment?

A) alendronic acid, and calcium and vitamin D
B) calcium and vitamin D, and intravenous zoledronic acid
C) calcium and vitamin D
D) strontium ranelate
E) alendronic acid alone

3. A 43-year-old woman was admitted with right lower lobe pneumonia and was found to have atrial fibrillation. She had a history of bipolar disorder for which she was taking lithium. Her menstrual periods were normal.
Investigations on admission:
serum thyroid-stimulating hormone (TSH)0.98 mU/L (0.4-5.0)
serum free T428.1 pmol/L (10.0-22.0)
serum free T314.2 pmol/L (3.0-7.0)
Assay interference had been excluded.
Subsequent investigations:
serum sex hormone binding globulin64 nmol/L (40-137)
serum thyroid-hormone receptor ?-subunit0.8 IU/L (<1.0)
anti-thyroid peroxidase antibodiesnegative
What is the most likely diagnosis?

A) thyroid hormone resistance
B) non-thyroidal illness (sick euthyroid syndrome)
C) surreptitious ingestion of thyroxine
D) lithium-induced hyperthyroidism
E) TSHoma

4. A 63-year-old woman with diet-controlled type 2 diabetes mellitus was admitted with biventricular cardiac failure. She had a history of myocardial infarction 3 years previously. She was taking aspirin 75 mg daily, simvastatin 20 mg daily, furosemide 40 mg daily and ramipril 10 mg daily. She responded well to increased diuretic therapy.
Urinalysis showed glucose 1+.
Investigations:
haemoglobin112 g/L (115-165)
serum sodium135 mmol/L (137-144)
serum potassium4.7 mmol/L (3.5-4.9)
serum creatinine162 umol/L (60-110)
estimated glomerular filtration rate28 mL/min/1.73 m2 (>60)
serum troponin T<0.01 ug/L (<0.01)
haemoglobin A1c66 mmol/mol (20-42)
What is the most appropriate treatment for her diabetes after discharge?

A) gliclazide
B) linagliptin
C) dapagliflozin
D) exenatide
E) subcutaneous insulin

5. A 26-year-old man with type 1 diabetes mellitus attended a carbohydrate-counting course to facilitate tighter glucose control. He estimated that his carbohydrate ratio was 1:10 and 1 unit correction dose reduced his glucose by 3.0 mmol/L.
He planned to eat a meal containing 50 g of carbohydrate. His pre-meal glucose was 16.0 mmol/L with a target blood glucose of 7.0 mmol/L.
What is the correct dose of bolus insulin (units) that he should administer?

A) 8
B) 2
C) 6
D) 10
E) 4

Solutions: