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

1. A 62-year-old man was referred from the infectious diseases clinic. He had HIV infection and was taking treatment that included thymidine analogue nucleoside reverse transcriptase inhibitors. He had developed considerable loss of limb and gluteal subcutaneous fat. He had complained recently of polyuria and polydipsia and was found to have a fasting plasma glucose of 8.3 mmol/L (3.0-6.0).
What is the most appropriate treatment for his diabetes mellitus?

A) insulin
B) gliclazide
C) metformin
D) pioglitazone
E) exenatide

2. A 67-year-old woman with type 2 diabetes mellitus presented to the foot clinic with an ulcer at the plantar aspect of her fifth left toe. The ulcer probed to bone but there were no signs of inflammation. There had been a little improvement during 6 weeks of podiatric treatment, but there was some concern about possible osteomyelitis. An X-ray of toe 4 weeks previously had been normal.
What is the most appropriate next investigation?

A) white cell labelled scan
B) CT scan of foot
C) triple phase isotope bone scan
D) plain X-ray of foot
E) MR scan of foot

3. A 41-year-old man presented to his general practitioner with symptoms of palpitations, sweating and anxiety. His blood pressure was 160/102 mmHg. He was advised to take propranolol 40 mg twice daily but was admitted to hospital later that week with an episode of pulmonary oedema.
On examination at the time of admission, he was noted to be pale and sweating and he had a blood pressure of 210/124 mmHg. A phaeochromocytoma was suspected.
What is the most likely cause of the cardiovascular deterioration following administration of propranolol?

A) inadequate ?-adrenoceptor blockade because of the short half-life of the drug
B) inhibition of catechol-O-methyltransferase by propranolol leading to an increase in circulating noradrenaline
C) ?1-adrenoceptor blockade leading to acute left ventricular dysfunction
D) propranolol acting as an agonist at ?1-adrenoceptors
E) loss of ?2-adrenoceptor-mediated vasodilatation

4. 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

5. A 16-year-old girl presented with primary amenorrhoea. In early childhood she had undergone an inguinal herniorrhaphy. She had no other medical history of note. There was a family history of infertility affecting a maternal aunt.
On examination, she had adult breast development but no pubic or axillary hair. Examination was otherwise normal.
What test is most likely to aid diagnosis?

A) MR scan of pituitary and olfactory bulbs
B) blood karyotype
C) plasma gonadotropins
D) ultrasound scan of pelvis
E) ovarian antibody titres

Solutions: