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

1. A 19-year-old man presented with late development of his pubic and axillary hair. He was otherwise well and was not taking any medication. His serum testosterone concentration had been normal on two previous occasions.
On examination, he now had post-pubertal secondary sexual characteristics. He had 15-20 mL testes.
Investigations:
serum testosterone27.0 nmol/L (9.0-35.0)
serum sex hormone binding globulin28 nmol/L (10-62)
serum follicle-stimulating hormone2.0 U/L (1.0-7.0)
serum luteinising hormone2.9 U/L (1.0-10.0)
What is the chief product of the Sertoli cell?

A) oestrogen
B) anti-Muellerian hormone
C) serum sex hormone binding globulin
D) testosterone
E) kisspeptin

2. A 32-year-old woman presented at 34 weeks of pregnancy, after an episode of vaginal bleeding. Gestational diabetes had been diagnosed at 28 weeks and insulin was started at 29 weeks. Her pre-pregnancy body mass index was 32 kg/m2 (18-25) and there was no family history of diabetes. She was treated with betamethasone 12 mg over 2 days. She was taking 60 units of insulin subcutaneously daily (40 units prandial in three divided doses, and 20 units intermediate-acting insulin), which had been unchanged for 3 weeks.
On examination, she was apyrexial, her pulse was 96 beats per minute and her blood pressure was 124/74 mmHg. Urinalysis showed blood 1+, protein 1+, glucose 2+, ketones 3+.
Investigations:
serum sodium134 mmol/L (137-144)
serum potassium3.8 mmol/L (3.5-4.9)
serum chloride105 mmol/L (95-107) serum urea5.0 mmol/L (2.5-7.0) serum creatinine90 umol/L (60-110) random plasma glucose7.2 mmol/L
What is the most appropriate next step in management?

A) start intravenous insulin
B) discharge and monitor blood glucose at home
C) continue to monitor blood glucose in hospital
D) increase subcutaneous insulin doses by 2-4 units
E) measure venous bicarbonate

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

4. A 48-year-old man with an 8-year history of type 2 diabetes mellitus was referred because of poor glycaemic control. He had a history of myocardial infarction complicated by previous congestive cardiac failure. His current medication comprised metformin 850 mg three times daily and gliclazide 80 mg once daily. He had gained weight and his body mass index was 31 kg/m2 (18-25).
Investigations:
serum sodium143 mmol/L (137-144)
serum potassium4.4 mmol/L (3.5-4.9)
serum creatinine136 umol/L (60-110)
haemoglobin A1c74 mmol/mol (20-42)
According to NICE guidelines (CG87, May 2009), what is the most appropriate immediate next step in management to improve his glycaemic control?

A) start insulin treatment
B) add exenatide
C) add sitagliptin
D) increase the dose of gliclazide
E) add pioglitazone

5. A pregnant 36-year-old woman presented to the diabetes outpatient clinic. She had type 2
diabetes mellitus treated with diet, lifestyle changes and metformin 500 mg twice daily.
On examination, her blood pressure was 128/84 mmHg.
Investigations:
haemoglobin A1c47 mmol/mol (20-42)
urinary albumin:creatinine ratio1.6 mg/mmol (<3.5)
Which is the best agent to reduce the risk of pre-eclampsia in this patient?

A) aspirin
B) omega-3-marine triglycerides
C) labetalol
D) insulin
E) folic acid

Solutions: