Endocrinology and diabetes questions
for MRCP Part 1.

A 55-year-old man with type 2 diabetes for 10 years has never had retinal screening. Why is annual diabetic retinopathy screening important, and what is the most appropriate action now?

1. AA single screening at diagnosis is sufficient for life
2. BNo screening is needed unless he reports visual symptoms
3. CScreening is only relevant for type 1 diabetes
4. DArrange annual digital retinal photography screening promptly, as diabetic retinopathy can be asymptomatic until advanced and sight-threatening
5. EScreening should be delayed until he develops proteinuria

A patient with a large pituitary macroadenoma has bitemporal hemianopia on visual field testing. Which anatomical relationship explains this visual field defect?

1. ACompression of the optic chiasm, where fibres from the nasal retina (representing the temporal visual fields) decussate
2. BCompression of the optic nerve alone, unilaterally
3. CCompression of the occipital cortex
4. DCompression of the oculomotor nerve
5. ECompression of the optic tract only, sparing the chiasm

A 34-year-old man presents to the acute medical unit with a 3-week history of polyuria, polydipsia, and an unintentional 6 kg weight loss. His body mass index is 22.4 kg/m². On examination, he is alert, his pulse is 88 beats/min, blood pressure is 124/78 mmHg, and respiratory rate is 16 breaths/min. Capillary blood glucose is 18.6 mmol/L and blood beta-hydroxybutyrate is 2.1 mmol/L. Venous blood gas shows pH 7.38, bicarbonate 23 mmol/L, and lactate 1.2 mmol/L. Which of the following is the most appropriate next step in management?

1. ACommence metformin and arrange outpatient HbA1c testing
2. BInitiate subcutaneous basal-bolus insulin and request anti-GAD and IA-2 antibodies
3. CPrescribe a sulfonylurea and repeat capillary ketone testing in 48 hours
4. DStart fixed-rate intravenous insulin infusion and 0.9% sodium chloride
5. ECommence an SGLT2 inhibitor and arrange urgent pancreatic ultrasound

A 52-year-old man attends his GP surgery complaining of a 6-week history of worsening thirst, nocturia (waking 3 times per night), and lethargy. He has no significant past medical history and takes no regular medications. His BMI is 31.4 kg/m². A random laboratory venous plasma glucose measurement returns at 12.6 mmol/L. Capillary blood ketones are 0.2 mmol/L. Which of the following is the most appropriate next step regarding his diagnostic status?

1. AConfirm the diagnosis of diabetes mellitus immediately without requiring a second confirmatory blood sample
2. BArrange an oral glucose tolerance test (OGTT) in 2 weeks before confirming diagnosis
3. CRepeat the fasting plasma glucose within 14 days because a single reading is never diagnostic
4. DRequest a 24-hour urinary glucose excretion test
5. EMeasure serum fructosamine concentration to exclude laboratory error

A 29-year-old woman with newly diagnosed Graves disease was started on carbimazole 30 mg once daily 4 weeks ago. She presents to the emergency department with a 24-hour history of severe sore throat, painful swallowing, chills, and fever. On examination, her temperature is 38.8 °C, heart rate is 108 beats/min, and blood pressure is 118/74 mmHg. Examination of the oropharynx reveals erythematous tonsils with ulceration and exudate. What is the most appropriate immediate course of action?

1. APrescribe oral amoxicillin and advise continuing carbimazole
2. BHalve the carbimazole dose to 15 mg daily and review in 1 week
3. CSwitch carbimazole to propylthiouracil immediately and discharge with analgesia
4. DObtain throat swabs and await laboratory results before altering medications
5. EStop carbimazole immediately and arrange an urgent full blood count