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

1. A 35-year-old man presented with newly diagnosed type 2 diabetes mellitus. He had no medical history of note.
When should he inform the UK Driver and Vehicle Licensing Agency (DVLA) of his medical condition?

A) if he requires laser treatment to one eye
B) if he becomes unable to read a car number plate with one eye at 20.5 m
C) if he starts taking an oral hypoglycaemic agent
D) if he starts using basal night-time insulin
E) immediately

2. A 37-year-old woman presented with a 2-year history of increasingly frequent flushing episodes. She described alternating loose bowel motions and constipation. She had also noted menstrual irregularity. She had no respiratory symptoms. She denied headache or chest pain, but complained of palpitations.
On examination, she appeared well. Her blood pressure was 128/82 mmHg.
Investigations:
serum thyroid-stimulating hormone0.8 mU/L (0.4-5.0)
What is the most appropriate next investigation?

A) urinary metanephrines
B) plasma metanephrines
C) serum gonadotrophins
D) urinary 5-hydroxyindoleacetic acid
E) fasting plasma gut hormones

3. A 26-year-old woman was urgently referred to clinic with a 6-week history of retroorbital headaches and deteriorating vision. Her past medical history was unremarkable, although on questioning she admitted that she had recently found it increasingly difficult to cope with her busy job.
On examination, her pulse was 60 beats per minute and regular, and her blood pressure was 110/75 mmHg lying and 90/60 mmHg standing. She was pale and had dry skin. Visual acuities were reduced (6/12 right; 6/24 left), and she had a bitemporal inferior quadrantanopia.
Investigations:
serum sodium132 mmol/L (137-144) serum potassium4.0 mmol/L (3.5-4.9)
short tetracosactide Synacthen@ test (250 micrograms): serum cortisol (30 min after tetracosactide)185 nmol/L (>550)
plasma follicle-stimulating hormone2.7 U/L plasma luteinising hormone3.5 U/L serum prolactin1050 mU/L (<360) serum thyroid-stimulating hormone0.3 mU/L (0.4-5.0) serum free T48.0 pmol/L (10.0-22.0)
serum insulin-like growth factor 14.7 nmol/L (7.5-37.3)
MR scan of brainsee image

What is the most likely diagnosis?

A) prolactinoma
B) Rathke's cleft cyst
C) craniopharyngioma
D) non-functioning pituitary adenoma
E) autoimmune hypophysitis

4. A 36-year-old man of African origin attended the clinic 2 weeks after discharge from hospital following his first admission with diabetic ketoacidosis. He had made a rapid recovery and had been discharged taking subcutaneous insulin twice daily.
At clinic, he reported home blood glucose measurements of 4-6mmol/L, occasional symptomatichypoglycaemia and a total daily insulin dose of 12 units. He asked if his glucose-lowering treatment should change.
Which test is most likely to predict prolonged insulin independence?

A) genotyping for monogenic diabetes
B) anti-islet cell antibodies
C) anti-glutamic acid decarboxylase antibodies
D) glucagon-stimulated C-peptide concentration
E) fasting C-peptide concentration

5. A 55-year-old woman was referred with a 6-month history of type 2 diabetes mellitus. She was not taking any regular medication. She was a non-smoker. She drank 10 units of alcohol per week. Her general practitioner had arranged for her to see the community dietician as the patient had made significant changes to her diet.
On examination, she was obese with a body mass index of 31.8 kg/m2 (18-25). Her liver was not palpable.
Investigations:
serum ferritin310 ug/L (15-300)
serum total bilirubin16 umol/L (1-22)
serum alanine aminotransferase80 U/L (5-35)
serum aspartate aminotransferase75 U/L (1-31)
serum alkaline phosphatase150 U/L (45-105)
serum gamma glutamyl transferase35 U/L (4-35)
haemoglobin A1c67 mmol/mol (20-42)
serum cholesterol6.2 mmol/L (<5.2)
serum HDL cholesterol0.90 mmol/L (>1.55)
fasting serum triglycerides2.50 mmol/L (0.45-1.69)
What is the most appropriate management of her dyslipidaemia?

A) fenofibrate
B) metformin
C) omega-3-acid ethyl esters
D) simvastatin
E) ezetimibe

Solutions: