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

1. A 26-year-old man presented urgently, complaining of muscle pains. He had been found to have heterozygous familial hypercholesterolaemia 2 years previously owing to a mutation in the PCSK9 gene. He had a strong family history of premature vascular disease. He was taking atorvastatin 80 mg daily.
Investigations:
serum creatine kinase2782 U/L (24-195)
serum cholesterol5.7 mmol/L (<5.2)
After stopping atorvastatin, his serum creatine kinase fell to within the normal range.
What is the most appropriate next step in management?

A) start fluvastatin 40 mg
B) restart atorvastatin 10 mg
C) restart atorvastatin 40 mg
D) start ezetimibe 10 mg
E) start fenofibrate 100 mg

2. An 18-year-old man was referred with muscle weakness and cramps. His blood pressure was 108/60 mmHg.
Investigations:
serum sodium143 mmol/L (137-144) serum potassium2.4 mmol/L (3.5-4.9) serum bicarbonate32 mmol/L (20-28) serum magnesium0.96 mmol/L (0.75-1.05)
24-h urinary calcium3.6 mmol (2.5-7.5) 24-h urinary magnesium4.2 mmol (2.5-8.0)
plasma renin activity (after 30 min supine)6.4 pmol/mL/h (1.1-2.7) plasma aldosterone (after 30 min supine)680 pmol/L (135-400)
What is the most likely diagnosis?

A) Liddle's syndrome
B) Gitelman's syndrome
C) renal tubular acidosis
D) Bartter's syndrome
E) syndrome of apparent mineralocorticoid excess

3. A 55-year-old woman presented with a 3-week history of nausea and vomiting. Her only medical complaints were frequent dyspepsia, for which she was taking indigestion tablets, and asthma for which she was taking a salbutamol inhaler as required.
On examination, there was no evidence of lymphadenopathy, her chest was clear on auscultation and abdominal examination was normal.
Investigations (before and after taking omeprazole for 3 weeks):
beforeafternormal erythrocyte sedimentation rate (mm/1st h)44<30 serum creatinine (umol/L)17011060-110 serum corrected calcium (mmol/L)2.852.402.20-2.60
serum phosphate (mmol/L)1.90.8-1.4
serum angiotensin-converting enzyme (U/L)8525-82
plasma parathyroid hormone (pmol/L)0.44.40.9-5.4
What is the most likely cause of the hypercalcaemia?

A) sarcoidosis
B) primary hyperparathyroidism
C) parathyroid hormone-related peptide-secreting malignancy
D) multiple myeloma
E) milk-alkali syndrome

4. A 30-year-old man was reviewed in the diabetes clinic. He had type 1 diabetes mellitus of 6 months' duration, treated with subcutaneous insulin in a basal bolus regimen (short-acting insulin three times daily; long-acting insulin once daily).
Investigations:
haemoglobin A1c52 mmol/mol (20-42)
At what arterialised venous blood glucose threshold would a patient typically expect to develop neuroglycopenic symptoms?

A) <2.3 mmol/L
B) 3.1-3.4 mmol/L
C) 2.3-2.6 mmol/L
D) 3.5-3.9 mmol/L
E) 2.7-3.0 mmol/L

5. A 16-year-old boy was referred to the endocrine clinic with symptoms of delayed puberty.
On examination, he had a reduced sense of smell, small-sized testes and underdeveloped
secondary sexual characteristics.
Investigations:
serum testosterone3.5 nmol/L (9.0-35.0)
serum follicle-stimulating hormone1.0 U/L (1.0-7.0)
serum luteinising hormone1.5 U/L (1.0-10.0)
serum prolactin220 mU/L (<360)
MR scan of brainnormal
He asked about his future fertility.
What will be the most useful agent for him to achieve fertility?

A) bromocriptine
B) clomifene
C) gonadotropin-releasing hormones
D) octreotide
E) testosterone

Solutions: