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

1. A 46-year-old Afro-Caribbean man with sarcoidosis was found to have hypercalcaemia and was treated with prednisolone 20 mg/day. Within 3 weeks his serum calcium had fallen to within the reference range.
How do glucocorticoids reduce serum calcium in sarcoidosis?

A) reduces extrarenal 1-?-hydroxylase activity
B) suppress parathyroid hormone secretion
C) direct calcium shift into cells
D) promote urinary calcium excretion
E) increase intravascular fluid volume

2. A 27-year-old woman with type 1 diabetes mellitus was invited to attend a structured education (e.g. DAFNE) coursE.
Which quality of life domain is most affected when a person is found to have type 1 diabetes mellitus?

A) family life
B) working life and work-related opportunities
C) sex life
D) freedom to eat as one wishes
E) enjoyment of leisure activities

3. A 59-year-old man with an 8-year history of type 2 diabetes mellitus was seen in the outpatient clinic. He had worsening renal function in the absence of microalbuminuria.
On examination, his blood pressure was 175/90 mmHg. He had a femoral bruit, and absent dorsalis pedis pulses bilaterally.
Investigations:
serum creatinine150 umol/L (60-110)
estimated glomerular filtration rate (MDRD)39 mL/min/1.73m2 (>60)
In addition to addressing his blood pressure, what is the most appropriate next investigation?

A) mercaptoacetyltriglycine (MAG3) renography
B) captopril diethylene triamine pentacaetic acid (DTPA) scan
C) renal ultrasound scan with Doppler studies
D) MR angiography of renal arteries
E) lower limb angiography

4. A 56-year-old man presented with a 6-month history of erectile dysfunction. He had noticed a gradual reduction in his frequency of shaving from daily to twice a week. His libido had diminished and he felt that he was not as strong as he once was. He also described general aches and pains. He was a farm worker and had drunk a bottle of vodka daily for several years, but had stopped drinking 2 years previously. He was a non-smoker.
Investigations:
serum urea6.2 mmol/L (2.5-7.0)
serum creatinine89 umol/L (60-110)
serum albumin40 g/L (37-49)
serum total bilirubin17 umol/L (1-22) serum alanine aminotransferase48 U/L (5-35) serum aspartate aminotransferase37 U/L (1-31) haemoglobin A1c55 mmol/mol (20-42)
serum cortisol (09.00 h)389 nmol/L (200-700) serum testosterone0.7 nmol/L (9.0-35.0) plasma follicle-stimulating hormone2.1 U/L (1.0-7.0) plasma luteinising hormone2.4 U/L (1.0-10.0) serum prolactin458 mU/L (<360) serum thyroid-stimulating hormone3.4 mU/L (0.4-5.0)
MR scan of pituitarysee image

What is the most likely explanation of his symptoms?

A) pituitary adenoma
B) age-related hypogonadism
C) haemochromatosis
D) cirrhosis of liver
E) hyperprolactinaemia

5. A 42-year-old motor mechanic was referred to the dermatologist with small cauliflower-like deposits on the points of his elbows. He was generally well, but on systemic enquiry, he described intermittent claudication. He had previously been hypertensive, and was taking thyroxine for primary hypothyroidism.
On examination, he was moderately obese. He had xanthelasmata on the upper eyelids of both eyes and tuberoeruptive xanthomata on both elbows, both knees and the nape of the neck.
Investigations:
serum alanine aminotransferase78 U/L (5-35)
fasting plasma glucose7.8 mmol/L (3.0-6.0)
serum urate0.48 mmol/L (0.23-0.46)
serum cholesterol13.4 mmol/L (<5.2)
serum LDL cholesterolnot measurable
serum HDL cholesterol0.90 mmol/L (>1.55)
fasting serum triglycerides9.32 mmol/L (0.45-1.69)
apolipoprotein E genotypehomozygous for apolipoprotein E2
What is the most likely diagnosis?

A) abetalipoproteinaemia
B) heterozygous familial hypercholesterolaemia
C) type III hyperlipidaemia (dysbetalipoproteinaemia)
D) familial combined hyperlipidaemia
E) lipoprotein lipase deficiency

Solutions: