MRCPUK SEND : Endocrinology and Diabetes (Specialty Certificate Examination)

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

1. A 66-year-old woman was admitted with carpopedal spasm. During the previous week she had had 2 days of diarrhoea following treatment with ciprofloxacin for a urinary tract infection. She had long-standing rheumatoid arthritis treated with prednisolone 5 mg daily, and was also taking alendronic acid, omeprazole and furosemide.
Investigations:
serum creatinine115 ?mol/L (60-110)
serum corrected calcium1.79 mmol/L (2.20-2.60)
serum alkaline phosphatase124 U/L (45-105)
serum magnesium0.26 mmol/L (0.75-1.05)
plasma parathyroid hormone2.7 pmol/L (0.9-5.4)
Which medicine is most likely to be responsible for her metabolic derangement?

A) alendronic acid
B) furosemide
C) prednisolone
D) omeprazole
E) ciprofloxacin

2. A 55-year-old woman presented with thirst, polyuria and polydipsia. Her symptoms had started 9 months previously following a road traffic accident. Her past medical history was normal and she was not taking any regular medication.
On examination, her blood pressure was 130/80 mmHg with no postural drop. Urine volume measured 5 L in 24 hours.
Investigations:
serum sodium131 mmol/L (137-144) serum potassium3.6 mmol/L (3.5-4.9) serum urea2.0 mmol/L (2.5-7.0) serum corrected calcium2.40 mmol/L (2.20-2.60) fasting plasma glucose6.4 mmol/L (3.0-6.0) serum osmolality278 mosmol/kg (278-300) urinary osmolality100 mosmol/kg (100-1000)
What is the most likely diagnosis?

A) diabetes mellitus
B) syndrome of inappropriate antidiuretic hormone
C) primary polydipsia
D) nephrogenic diabetes insipidus
E) cranial diabetes insipidus

3. A 69-year-old man with type 2 diabetes mellitus presented with a 3-day history of an ulcer on his right second toe.
On examination, the toe was red, swollen and enlarged, and looked like a 'sausage digit'. The ulcer appeared superficial.
Investigations:
X-ray of right second toeno sign of osteomyelitis
Cultures from the debrided wound bed were taken and the results were awaited.
What is the most appropriate type of antibiotic regimen to start empirically before the culture results are available?

A) no antibiotic
B) broad spectrum for 6 weeks
C) narrow spectrum for 6 weeks
D) broad spectrum for 10 days
E) narrow spectrum for 10 days

4. A 36-year-old woman was referred to the endocrine clinic with abnormal thyroid function
tests. She gave a 3-year history of increased sweating and anxiety following an assault and, initially, her symptoms had been attributed to post-traumatic stress disorder.
Investigations:
serum thyroid-stimulating hormone (TSH)3.1 mU/L (0.4-5.0)
serum free T429.8 pmol/L (10.0-22.0)
serum free T33.5 pmol/L (3.0-7.0)
What is the most likely interpretation of her thyroid function test results?

A) use of combined oral contraceptive pill
B) TSH-secreting pituitary adenoma
C) factitious thyrotoxicosis
D) assay interference
E) resistance to thyroid hormone

5. A 62-year-old man was referred from the infectious diseases clinic. He had HIV infection and was taking treatment that included thymidine analogue nucleoside reverse transcriptase inhibitors. He had developed considerable loss of limb and gluteal subcutaneous fat. He had complained recently of polyuria and polydipsia and was found to have a fasting plasma glucose of 8.3 mmol/L (3.0-6.0).
What is the most appropriate treatment for his diabetes mellitus?

A) insulin
B) exenatide
C) metformin
D) gliclazide
E) pioglitazone

Solutions: