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

1. An 18-year-old man, whose ambition was to become a member of the elite armed forces, presented with gynaecomastia. His weekly alcohol consumption was 35 units.
On examination, he had normal secondary sexual characteristics, a well-developed, muscular physique and modest, slightly tender bilateral gynaecomastia. Testes were 10 mL with soft texture.
Investigations:
haemoglobin160 g/L (130-180)
MCV96 fL (80-96)
serum dehydroepiandrosterone sulphate4 umol/L (2-10)
serum oestradiol180 pmol/L (<180)
serum testosterone (09.00 h)6.0 nmol/L (9.0-35.0)
plasma follicle-stimulating hormone1.0 U/L (1.0-7.0)
plasma luteinising hormone0.7 U/L (1.0-10.0)
serum prolactin420 mU/L (<360)
What is the most likely diagnosis?

A) alcohol excess
B) oestrogen-secreting testicular tumour
C) persistence of pubertal gynaecomastia
D) primary hypogonadotrophic hypogonadism
E) androgen abuse

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

3. A 42-year-old woman, with type 1 diabetes mellitus of 22 years' duration, attended for annual review. She was using biphasic insulin twice daily and taking aspirin 75 mg, simvastatin 40 mg and ramipril 10 mg daily.
On examination, her blood pressure was 164/87 mmHg.
Investigations:
serum potassium5.9 mmol/L (3.5-4.9)
serum creatinine197 umol/L (60-110)
estimated glomerular filtration rate (MDRD)26 mL/min/1.73 m2 (>60)
haemoglobin A1c72 mmol/mol (20-42)
urinary albumin:creatinine ratio27.0 mg/mmol (<3.5)
urine culturenegative
What is the most important next step in management?

A) change to intensive insulin regimen
B) refer to a nephrologist
C) add furosemide
D) add aliskiren
E) check bicarbonate

4. A 73-year-old man with type 2 diabetes mellitus was reviewed because of deteriorating
blood glucose control. He was taking metformin 850 mg twice daily.
On examination, his body mass index was 29 kg/m2 (18-25).
Investigations:
serum creatinine102 umol/L (60-110)
haemoglobin A1c66 mmol/mol (20-42)
According to the NICE guidelines (CG87, May 2009), what would be the most appropriate
additional treatment?

A) thiazolidinedione
B) exenatide
C) insulin glargine
D) sitagliptin
E) sulfonylurea

5. A 55-year-old woman presented with a 3-week history of nausea and vomiting. Her only medical complaints were frequent dyspepsia, for which she was taking indigestion tablets, and asthma for which she was taking a salbutamol inhaler as required.
On examination, there was no evidence of lymphadenopathy, her chest was clear on auscultation and abdominal examination was normal.
Investigations (before and after taking omeprazole for 3 weeks):
beforeafternormal erythrocyte sedimentation rate (mm/1st h)44<30 serum creatinine (umol/L)17011060-110 serum corrected calcium (mmol/L)2.852.402.20-2.60
serum phosphate (mmol/L)1.90.8-1.4
serum angiotensin-converting enzyme (U/L)8525-82
plasma parathyroid hormone (pmol/L)0.44.40.9-5.4
What is the most likely cause of the hypercalcaemia?

A) sarcoidosis
B) primary hyperparathyroidism
C) milk-alkali syndrome
D) parathyroid hormone-related peptide-secreting malignancy
E) multiple myeloma

Solutions: