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

1. A 72-year-old man with a 12-year history of type 2 diabetes mellitus was found to have carcinoma of the bladder. He was taking metformin; however, this was stopped because of his deteriorating renal function.
On examination, his weight was 95 kg and his body mass index was 32 kg/m2 (18-25).
Investigations:
serum sodium143 mmol/L (137-144)
serum potassium4.4 mmol/L (3.5-4.9)
serum creatinine175 umol/L (60-110)
estimated glomerular filtration rate (MDRD)27 mL/min/1.73 m2 (>60)
haemoglobin A1c64 mmol/mol (20-42)
What is the most appropriate addition to his medication?

A) sitagliptin
B) dapagliflozin
C) liraglutide
D) gliclazide
E) pioglitazone

2. A 70-year-old man was admitted after the gradual development of confusion. He had no
significant medical history.
Examination was otherwise normal.
Investigations:
serum sodium110 mmol/L (137-144)
serum potassium3.8 mmol/L (3.5-4.9)
serum creatinine50 umol/L (60-110)
He was treated with several litres of sodium chloride 0.9% over the subsequent few days, resulting in a rapid restoration of serum sodium to the normal range. This coincided with the development of limb weakness and spasticity that became permanent.
The movement of what substance(s) between the intracellular fluid compartment (ICF) and extracellular fluid compartment (ECF) explains the changes in this patient?

A) sodium from ECF to ICF
B) water from ECF to ICF
C) sodium and water from ECF to ICF
D) water from ICF to ECF
E) sodium from ICF to ECF

3. Carbimazole is routinely used in the management of thyroid disease.
What does carbimazole inhibit?

A) thyroid peroxidase
B) thyroglobulin synthesis
C) sodium/iodide symporter
D) deiodinase type 1
E) presentation of thyroid antigens to autoreactive T cells

4. A 48-year-old man was investigated for a 6-month history of tiredness. There was no other medical history and he was taking no medication.
Investigations:
estimated glomerular filtration rate (MDRD)36 mL/min/1.73 m2 (>60) serum corrected calcium2.25 mmol/L (2.20-2.60) serum phosphate1.1 mmol/L (0.8-1.4)
plasma parathyroid hormone8.1 pmol/L (0.9-5.4) serum 25-OH-cholecalciferol48 nmol/L (45-90)
What is the most important next step in management?

A) refer for parathyroidectomy
B) reassure and repeat in 3 months
C) refer for nephrological advice
D) reassure and discharge from clinic
E) prescribe calcium and vitamin D supplements

5. A 28-year-old Asian woman was seen in the joint diabetes-antenatal clinic at 16 weeks' gestation. She gave a history of gestational diabetes during her previous pregnancy. She had a strong family history of diabetes mellitus. She was fit and well, and had no symptoms other than slight early morning sickness.
According to NICE guidance (NG3, February 2015) for management of pregnancy, what is the most appropriate way to screen for gestational diabetes in this woman?

A) oral glucose tolerance test at 24-28 weeks' gestation
B) oral glucose tolerance test as soon as possible
C) haemoglobin A1c
D) 2-h postprandial plasma glucose
E) fasting plasma glucose

Solutions: