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

1. A 55-year-old man with mild polyuria and tiredness was seen on a renal ward. He had had a living-related kidney transplant 6 months previously. He had good graft function while being treated with prednisolone 5 mg daily, mycophenolate mofetil 1 g twice daily and tacrolimus 3 mg twice daily. He was also taking atenolol 50 mg daily and simvastatin 40 mg daily.
Investigations:
haemoglobin A1c75 mmol/mol (20-42)
random plasma glucose18.0 mmol/L
Which drug is most likely to be responsible for his diabetes of new onset?

A) mycophenolate mofetil
B) atenolol
C) prednisolone
D) tacrolimus
E) simvastatin

2. A 55-year-old man presented with a 3-year history of increasing pain in the right hip. He had been otherwise well and was taking no medication. He was reluctant to consider any intravenous treatment as he had a phobia of needles.
Investigations:
X-ray of hipssclerotic bone in right pubis and ischium
suggestive of Paget's disease
What is the most appropriate oral treatment?

A) strontium ranelate
B) sodium clodronate
C) risedronate sodium
D) calcium and vitamin D
E) ibandronate sodium

3. A 17-year-old boy had panhypopituitarism, including diabetes insipidus, following treatment for a craniopharyngioma. He was taking appropriate replacement therapy. In the transition clinic, he was keen to continue growth hormone replacement therapy following a 12-month break after reaching final height.
Which is the most appropriate test to assess his growth hormone status?

A) clonidine test
B) growth hormone day profile
C) insulin-like growth factor 1
D) insulin tolerance test
E) insulin-like growth factor-binding protein 3

4. A 32-year-old man presented to the emergency department after becoming acutely unwell. He had a 5-year history of type 1 diabetes mellitus and no other significant medical history.
On examination, he was apyrexial, his pulse was 120 beats per minute, his blood pressure was 96/58 mmHg and his respiratory rate was 32 breaths per minute.
Investigations:
random plasma glucose14.2 mmol/L
arterial blood gases, breathing 60% oxygen:
PO28.9 kPa (11.3-12.6)
PCO22.6 kPa (4.7-6.0)
pH7.10 (7.35-7.45)
H+79 nmol/L (35-45)
bicarbonate6.1 mmol/L (21-29)
base excess-18 mmol/L (+-2)
What diagnosis is most likely to account for these results?

A) salicylate poisoning
B) acute myocardial infarction
C) acute asthma
D) diabetic ketoacidosis
E) diabetic ketoacidosis and pulmonary embolism

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

Solutions: