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

1. A 17-year-old Caucasian girl presented with primary amenorrhea.
On examination, her body mass index was 21 kg/m2 (18-25). Her body habitus was normal and she had appropriate breast development. There was no hirsutism or acne.
Investigations:
serum oestradiol<180 pmol/L (200-400) serum testosterone31.7 nmol/L (0.5-3.0) serum follicle-stimulating hormone4.0 U/L (2.5-10.0) serum luteinising hormone6.0 U/L (2.5-10.0)
What is the most likely diagnosis?

A) androgen-secreting ovarian tumour
B) adrenocortical carcinoma
C) polycystic ovary syndrome
D) ovarian hyperthecosis
E) complete androgen insensitivity syndrome

2. A 77-year-old woman presented with a 10-week history of facial hirsutism, scalp hair loss and deepening of the voice.
On examination, her body mass index was 32 kg/m2 (18-25). Her blood pressure was 164/94 mmHg. She had coarse terminal hairs on her upper lip and beard areas. Abdominal examination was normal, but she refused examination of her external genitalia.
Investigations:
serum sodium144 mmol/L (137-144) serum potassium3.6 mmol/L (3.5-4.9) serum urea7.7 mmol/L (2.5-7.0) serum creatinine122 umol/L (60-110) fasting plasma glucose6.4 mmol/L (3.0-6.0) serum testosterone17.2 nmol/L (0.5-3.0) serum luteinising hormone2.2 U/L (>30.0)
What is the most appropriate initial investigation?

A) overnight dexamethasone suppression test (after 1 mg dexamethasone)
B) serum dehydroepiandrosterone sulphate
C) CT scan of abdomen and pelvis
D) serum oestradiol
E) plasma adrenocorticotropic hormone and serum cortisol

3. A 40-year-old man presented with a 4-month history of increasing central obesity. His medical history included HIV infection and allergic rhinitis. He was taking highly active antiretroviral therapy and nasal fluticasone.
On examination, he had marked central adiposity. His blood pressure was 160/95 mmHg.
Investigations:
serum sodium140 mmol/L (137-144)
serum potassium3.8 mmol/L (3.5-4.9)
serum cholesterol5.5 mmol/L (<5.2)
fasting serum triglycerides8.20 mmol/L (0.45-1.69)
serum cortisol (09.00 h)<50 nmol/L (200-700)
serum thyroid-stimulating hormone4.6 mU/L (0.4-5.0)
serum free T49.3 pmol/L (10.0-22.0)
What is the most likely diagnosis?

A) glucocorticoid resistance
B) hypothyroidism
C) Cushing's syndrome
D) Addison's disease
E) HIV-associated lipodystrophy

4. A 23-year-old woman was found to have type 1 diabetes mellitus following a short history of polyuria, polydipsia and unintentional weight loss. She started taking insulin aspart before meals and insulin detemir daily.
What is the most appropriate time from diagnosis to start screening for microalbuminuria?

A) 2 years
B) 1 year
C) immediately
D) 10 years
E) 5 years

5. 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) exenatide
B) dapagliflozin
C) subcutaneous insulin
D) gliclazide
E) linagliptin

Solutions: