最新のSEND問題集で試験を準備する

MRCPUK SEND 試験概要:

MRCPUK SEND 試験シラバストピック:

MRCPUK Endocrinology and Diabetes (Specialty Certificate Examination) 認定 SEND 試験問題：

1. A 54-year-old woman was referred for assessment of low bone mineral density. Three months previously, after complaining of bloating and flatulence, she had been found to have coeliac disease and had been started on a gluten-free diet. She had no history of fracture and had not lost height. There was no family history of osteoporosis. Her only medication was omeprazole.
Investigations:
serum corrected calcium2.42 mmol/L (2.20-2.60) serum alkaline phosphatase122 U/L (45-105)
plasma parathyroid hormone7.9 pmol/L (0.9-5.4)
DXA scansee image What is the most appropriate treatment?

A) calcium and vitamin D
B) alendronic acid alone
C) alendronic acid, and calcium and vitamin D
D) strontium ranelate
E) calcium and vitamin D, and intravenous zoledronic acid

2. A 25-year-old woman with type 1 diabetes mellitus was admitted to hospital with a 12-hour
history of nausea and lethargy.
On examination, her temperature was 37.5C, she was dehydrated and her Glasgow coma
score was 14. Urinalysis showed glucose 2+, ketones 3+, protein negative.
Investigations:
white cell count12.0 ? 109/L (4.0-11.0)
neutrophil count8.0 ? 109/L (1.5-7.0)
random plasma glucose22.0 mmol/L
arterial blood gases, breathing air:
pH7.20 (7.35-7.45)
serum C-reactive protein12 mg/L (<10)
She was treated with intravenous sodium chloride 0.9% and fixed-rate intravenous insulin
infusion, and initially improved. Twelve hours into her admission, she complained of a
headache.
On examination, her temperature was 37.3C and her Glasgow coma score was 15. Her
pulse was 85 beats per minute and her blood pressure was 110/70 mmHg. There was no
neck stiffness, papilloedema or focal neurological signs.
What is the most likely cause for her headache?

A) sagittal sinus thrombosis
B) bacterial meningitis
C) tension headache
D) viral encephalitis
E) cerebral oedema

3. A 55-year-old woman was referred with a 6-month history of type 2 diabetes mellitus. She was not taking any regular medication. She was a non-smoker. She drank 10 units of alcohol per week. Her general practitioner had arranged for her to see the community dietician as the patient had made significant changes to her diet.
On examination, she was obese with a body mass index of 31.8 kg/m2 (18-25). Her liver was not palpable.
Investigations:
serum ferritin310 ug/L (15-300)
serum total bilirubin16 umol/L (1-22)
serum alanine aminotransferase80 U/L (5-35)
serum aspartate aminotransferase75 U/L (1-31)
serum alkaline phosphatase150 U/L (45-105)
serum gamma glutamyl transferase35 U/L (4-35)
haemoglobin A1c67 mmol/mol (20-42)
serum cholesterol6.2 mmol/L (<5.2)
serum HDL cholesterol0.90 mmol/L (>1.55)
fasting serum triglycerides2.50 mmol/L (0.45-1.69)
What is the most appropriate management of her dyslipidaemia?

A) simvastatin
B) metformin
C) ezetimibe
D) fenofibrate
E) omega-3-acid ethyl esters

4. A 49-year-old woman presented with a mass in her neck that was causing no specific symptoms.
Examination revealed a solitary nodule in the right thyroid lobe, with no associated lymphadenopathy. Thyroid function was normal. No other abnormality was noted. There was no evidence of lymphadenopathy in the neck.
Investigations:
ultrasound scan of necksolid hypoechoic nodule 1.8 ? 1.2 ? 1 cm
in right thyroid lobe;
cyst 0.6 ? 0.3 ? 0.2 cm in left thyroid lobe
cytology (fine-needle aspirationscanty colloid with abundant
from nodule in right lobe)thyroid follicular cells (Thy3f)
What is the most appropriate next step in management?

A) serum thyroglobulin
B) thyroid lobectomy for histological diagnosis
C) repeat cytology for confirmation
D) reassure that the nodule is not malignant and discharge
E) total thyroidectomy for histological diagnosis

5. A 62-year-old woman was referred with generalised weakness. She had no previous history of note and was not taking any medication. She reported drinking 60 units of alcohol per week.
On examination, she was found to have central adiposity, pale abdominal striae and
wasting of the limb muscles. Her blood pressure was raised at 160/100 mmHg.
Investigations:
serum sodium138 mmol/L (137-144)
serum potassium3.8 mmol/L (3.5-4.9)
serum cortisol (09.00 h)750 nmol/L (200-700)
low-dose dexamethasone suppression test (2 mg/day for 48 h):
serum cortisol120 nmol/L (<50)
high-dose dexamethasone suppression test (8 mg/day for 48 h):
serum cortisol45 nmol/L (should suppress to
<50% of day 0 value)
24-h urinary free cortisol 360 nmol (55-250)
plasma adrenocorticotropic hormone (09.00 h)22.0 pmol/L (3.3-15.4)
MR scan of pituitary glandnormal
CT scan of adrenal glands1-cm mass in the left adrenal gland
What is the most likely cause for her presentation?

A) pseudo-Cushing's syndrome
B) ectopic adrenocorticotropic hormone syndrome
C) adrenal adenoma
D) adrenal carcinoma
E) Cushing's disease

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