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

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

2. A 25-year-old woman presented at 28 weeks' gestation after a screening 75-g oral glucose tolerance test, which had shown a fasting plasma glucose of 5.6 mmol/L (3.0-6.0) and a 2h plasma glucose of 9.8 mmol/L (<7.8). She had a family history of type 2 diabetes mellitus and a pre-pregnancy body mass index of 36 kg/m2 (18-25). Home blood glucose monitoring had shown persistently raised blood glucose despite dietary modification. She refused insulin because of needle phobia and was concerned about drug exposure to her unborn child.
The use of what hypoglycaemic therapy is acceptable in this situation?

A) pioglitazone
B) gliclazide
C) glibenclamide
D) exenatide
E) sitagliptin

3. A 67-year-old woman presented to her general practitioner with a swelling in her neck. It had been present for 4-5 years and had not changed in size during that time. She was completely asymptomatic and remained well.
On examination, there was a nodular goitre and no lymphadenopathy.
Investigations:
serum thyroid-stimulating hormone1.1 mU/L (0.4-5.0)
A subsequent ultrasound scan demonstrated seven nodules bilaterally (ranging in size from 5 mm to 15 mm), which had no suspicious features.
What is the most appropriate next step in management according to British Thyroid Association 2014 Guidelines for the Management of Thyroid Cancer?

A) levothyroxine 100 micrograms daily
B) subtotal thyroidectomy
C) reassure and discharge
D) fine-needle aspiration of largest nodule
E) radioactive iodine

4. A 26-year-old man with type 1 diabetes mellitus attended a carbohydrate-counting course to facilitate tighter glucose control. He estimated that his carbohydrate ratio was 1:10 and 1 unit correction dose reduced his glucose by 3.0 mmol/L.
He planned to eat a meal containing 50 g of carbohydrate. His pre-meal glucose was 16.0 mmol/L with a target blood glucose of 7.0 mmol/L.
What is the correct dose of bolus insulin (units) that he should administer?

A) 8
B) 2
C) 4
D) 6
E) 10

5. A 45-year-old man had type 2 diabetes mellitus of 2 years' duration. He had no history of ischaemic heart disease or microvascular complications, and was euthyroid. There was no family history of ischaemic heart disease. He was a non-smoker and drank 4 to 8 units of alcohol per week. He was taking metformin only.
On examination, his blood pressure was 120/78 mmHg and his body mass index was 24 kg/m2 (18-25).
His calculated 10-year cardiovascular risk was 8.5%.
Investigations (fasting):
serum sodium142 mmol/L (137-144)
serum potassium3.8 mmol/L (3.5-4.9)
serum creatinine90 umol/L (60-110)
haemoglobin A1c48 mmol/L (20-42)
urinary albumin:creatinine ratio1.5 mg/mmol (<2.5)
serum cholesterol5.1 mmol/L (<5.2)
serum HDL cholesterol1.50 mmol/L (>1.55)
fasting serum triglycerides1.22 mmol/L (0.45-1.69)
What does the NICE guidance (CG181, July 2014) on type 2 diabetes mellitus recommend as the most appropriate next step in management?

A) omega-3 marine triglycerides
B) micronised fenofibrate
C) no change
D) atorvastatin
E) simvastatin

Solutions: