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

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

2. A 73-year-old man with type 2 diabetes mellitus was reviewed because of borderline hypertension. He was taking metformin 1 g twice daily, gliclazide 160 mg twice daily, aspirin 75 mg daily and simvastatin 20 mg at night. He had a history of diabetic retinopathy.
On examination, his body mass index was 34 kg/m2 (18-25); his blood pressure was 146/86 mmHg. When he returned 2 months later, his blood pressure was 142/88 mmHg.
Investigations:
serum creatinine102 umol/L (60-110)
haemoglobin A1c66 mmol/mol (20-42)
urinary albumin:creatinine ratio
(untimed specimen)7.4 mg/mmol (<2.5)
According to NICE guidelines (CG66, May 2008), what is the target for blood pressure reduction?

A) <120/70 mmHg
B) <130/80 mmHg
C) <150/90 mmHg
D) <140/80 mmHg
E) <125/70 mmHg

3. A 20-year-old woman with Turner's syndrome had heard that there was a risk of ovarian cancer associated with Turner's syndrome. She asked to undergo a pre-emptive oophorectomy.
For what genotype is oophorectomy most likely to be recommended?

A) 45XO
B) 45X/46XY
C) 45X/46XX
D) 45X/47XXX
E) 45X/46Xxi (Xq)

4. An 18-year-old woman was found to have a blood pressure of 164/102 mmHg at a preemployment medical examination. She gave no family history of hypertension. On enquiry, she said that she had not yet started to menstruate.
On initial clinical examination, she appeared well. She was 1.72 m tall (>90th centile) and had a body mass index of 22 kg/m2 (18-25). There was no evidence of axillary hair, and pubic hair was scanty (Tanner stage 1). Breast development was immature (Tanner stage 1).
Investigations:
serum sodium142 mmol/L (137-144)
serum potassium2.7 mmol/L (3.5-4.9)
serum urea4.6 mmol/L (2.5-7.0)
serum creatinine102 umol/L (60-110)
estimated glomerular filtration rate (MDRD)>60 mL/min/1.73 m2 (>60)
plasma renin activity (after 30 min supine)1.0 pmol/mL/h (1.1-2.7)
plasma aldosterone (after 30 min supine)125 pmol/L (135-400)
serum cortisol (09.00 h)190 nmol/L (200-700)
What is the most likely underlying diagnosis?

A) 11-hydroxysteroid dehydrogenase type 2 deficiency
B) adrenal 21-hydroxylase deficiency
C) adrenal 17-hydroxylase deficiency
D) deoxycorticosterone-secreting adrenal tumour
E) adrenal 11-hydroxylase deficiency

5. A 24-year-old man was referred for investigation of infertility. He had been having unprotected intercourse with his partner for 18 months, but the couple had failed to conceive. He had been treated for Hodgkin's lymphoma at the age of 17.
What is the most appropriate investigation?

A) serum inhibin
B) serum testosterone
C) serum follicle-stimulating hormone
D) semen analysis
E) testicular biopsy

Solutions: