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

1. A 43-year-old man presented with a 2-year history of tiredness and reduced libido. He had not been found to have diabetes mellitus.
On examination, his body mass index was 22.4 kg/m2 (18-25), he was poorly virilised and had 10 mL testes.
Investigations:
serum cortisol (09.00 h)220 nmol/L (200-700) serum testosterone4 nmol/L (9.0-35.0) plasma follicle-stimulating hormone1.2 U/L (1.0-7.0) plasma luteinising hormone1.2 U/L (1.0-10.0) serum prolactin150 mU/L (<360) serum thyroid-stimulating hormone1.2 mU/L (0.4-5.0) serum free T48.2 pmol/L (10.0-22.0)
serum insulin-like growth factor 17.8 nmol/L (5.6-23.3)
MR scan of pituitaryempty sella; no mass lesion
An insulin tolerance test was advised to assess both cortisol and growth hormone reserve.
What is the most appropriate dose of insulin (in units/kg body weight) to administer?

A) 0.05
B) 0.01
C) 0.5
D) 0.1
E) 1.0

2. A 55-year-old man with type 2 diabetes mellitus presented with foot swelling and discomfort. He had a peripheral sensory neuropathy attributed to diabetes mellitus. A midfoot Charcot's arthropathy was suspected, and a plain X-ray was arranged (see image).

Which is the talonavicular joint?

A) 1
B) 4
C) 3
D) 5
E) 2

3. A 17-year-old girl with Turner's syndrome attended the clinic for review. She had been treated with growth hormone therapy for the previous 7 years, and had now reached her final adult height.
What is the most appropriate next step in management?

A) stop growth hormone therapy
B) start to reduce growth hormone therapy with a view to discontinuing in 2 years' time
C) assess her bone density by DXA scan and continue growth hormone if bone mineral density is less than mean for age
D) withdraw growth hormone therapy for 3 months and evaluate growth hormone secretion
E) continue growth hormone until 25 years old then reassess

4. A 23-year-old barmaid presented with headache, sweating and collapse. She had a past medical history of tension headache and unexplained abdominal pain. Her regular medication included amitriptyline 25 mg at night and paracetamol 1 g as required. She was a smoker and regularly drank alcohol.
On examination, her pulse was 120 beats per minute and her blood pressure was 210/128 mmHg.
Investigations:
24-h urinary metanephrine5.4 umol (<2)
24-h urinary normetanephrine15.2 umol (<3) What substance is most likely to cause assay interference in the measurement of urinary metanephrines?

A) amitriptyline
B) caffeine
C) nicotine
D) alcohol
E) paracetamol

5. A 52-year-old man, with a 20-year history of type 2 diabetes mellitus, had been treated with metformin and, for the previous 4 years, biphasic insulin aspart twice daily. He had recently started a new job that required him to drive a 7.5-tonne vehicle.
If he were to apply for a UK Class C1 driving licence, who should complete the application form with him?

A) solicitor
B) general practitioner
C) occupational health physician
D) diabetes specialist nurse in secondary care
E) consultant physician specialising in diabetes

Solutions: