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

1. A 45-year-old woman attended for annual follow-up for long-standing hypoparathyroidism (a complication of thyroid surgery 5 years previously). She was asymptomatic. She was taking alfacalcidol 1 microgram daily.
Examination was unremarkable.
Investigations:
serum creatinine105 umol/L (60-110)
serum corrected calcium2.45 mmol/L (2.20-2.60)
24-h urinary calcium9.8 mmol (2.5-7.5)
What is the most appropriate next step in management?

A) change alfacalcidol to calcitriol
B) add bendroflumethiazide
C) recommend low-calcium diet
D) change alfacalcidol to teriparatide
E) decrease alfacalcidol dosage

2. A 26-year-old woman with type 1 diabetes mellitus was seen in the antenatal diabetes clinic and was 8 weeks pregnant. The father of her child also had type 1 diabetes mellitus. They were concerned that their child might develop type 1 diabetes mellitus.
What is the likelihood of the child developing type 1 diabetes mellitus?

A) 0.1-1%
B) 85-100%
C) 5-10%
D) 25-40%
E) 55-75%

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

4. A 50-year-old man with a 9-year history of type 2 diabetes mellitus presented with excessive tiredness. His partner said that he snored excessively. His haemoglobin A1c was usually between 64 and 75 mmol/mol (20-42). He was taking glimepiride 4 mg daily and orlistat. He was intolerant of metformin.
On examination, he had reduced sensation to a 10-g monofilament, and extensive background diabetic retinal changes. His Epworth sleepiness score was 13/24. His body mass index was 36 kg/m2 (18-25) despite compliance with orlistat.
According to the NICE guidelines (CG87, May 2009), what is the most appropriate treatment?

A) dipeptidyl peptidase-4 inhibitor
B) glucagon-like peptide-1 agonist
C) acarbose
D) basal bolus insulin
E) bariatric surgery

5. A 50-year-old woman noticed some swelling of her right great toe and a painful right foot. She had type 1 diabetes mellitus of 21 years' duration and recent screening had revealed some mild diabetic retinal changes and peripheral neuropathy.
On examination, she had a hot, red right forefoot with swelling of the great toe. There was callus on the first metatarsal head with a blister beneath it. After de-roofing, the podiatrist probed to a depth of 1 cm. The left foot demonstrated reduced sensation to a 10-g monofilament. Her right foot was 0.6C hotter than the left.
What is the most likely diagnosis?

A) necrotising fasciitis
B) gout
C) Charcot's foot
D) osteoarthritis
E) osteomyelitis

Solutions: