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

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

2. A 72-year-old woman presented with a painless swelling in the front of the neck, which she had first noticed 2-3 months previously. She was otherwise well, with no symptoms of mass effect in her neck, and was not taking any medication.
On examination, her thyroid gland was moderately enlarged, and felt uniformly nodular. There was no associated lymphadenopathy. Her pulse was 78 beats per minute and regular, and there were no signs of thyrotoxicosis.
Investigations:
serum thyroid-stimulating hormone<0.01 mU/L (0.4-5.0)
serum free T424.8 pmol/L (10.0-22.0)
serum free T310.3 pmol/L (3.0-7.0)
technetium-99m scan of thyroid (20-min uptake)patchy uptake in both thyroid lobes
What is the most appropriate management?

A) partial thyroidectomy
B) repeat thyroid function tests after 6 months
C) radioiodine
D) carbimazole plus levothyroxine
E) total thyroidectomy

3. A 73-year-old man with type 2 diabetes mellitus was referred to the outpatient clinic. He had a history of microalbuminuria and hypertension. He was taking ramipril, amlodipine and metformin.
On examination, his blood pressure was 125/75 mmHg.
Investigations:
haemoglobin A1c57 mmol/mol (20-42)
What additional drug is most likely to prevent glomerular filtration rate decline?

A) linagliptin
B) aliskiren
C) losartan
D) aspirin
E) simvastatin

4. 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) metformin
C) exenatide
D) gliclazide
E) pioglitazone

5. A 56-year-old woman was referred for assessment of asymptomatic hypercalcaemia.
Investigations:
serum corrected calcium2.73 mmol/L (2.20-2.60)
plasma parathyroid hormone8.9 pmol/L (0.9-5.4)
urinary calcium:creatinine clearance ratio0.002
An X-ray of abdomen was normal and imaging of her neck showed no evidence of a
parathyroid adenoma.
What is the pattern of inheritance of this condition?

A) autosomal dominant
B) X-linked dominant
C) X-linked recessive
D) autosomal recessive
E) mitochondrial

Solutions: