SENDの無料問題集（200題）、SEND認定試験参考書

MRCPUK SEND 問題集

試験コード：SEND

試験名称：Endocrinology and Diabetes (Specialty Certificate Examination)

最近更新時間：2025-01-14

問題と解答：全200問

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質問 1：
A 64-year-old woman presented with features of acromegaly. An MR scan showed a pituitary tumour with cavernous sinus extension. She underwent trans-sphenoidal surgery and histology of the pituitary tissue showed numerous cells immunostaining for growth hormone.
Investigations (6 months postoperatively):
MR scan of pituitaryenlarged sella, residual tumour in right cavernous sinus
serum growth hormone (day curve average)3.2 ?g/L (<2)
serum insulin-like growth factor 142.0 nmol/L (3.3-23.3)
What is the most appropriate next step in management?
A. watchful waiting
B. conventional external beam radiotherapy to pituitary region
C. long-acting octreotide
D. pegvisomant
E. repeat trans-sphenoidal surgery
正解：C

質問 2：
A 17-year-old girl presented with primary amenorrhoea. She had grown and developed normally. There was no history of galactorrhoea or hirsutism.
On examination, her height was 1.69 m, her weight was 68.3 kg, and her body mass index was 23.9 kg/m2 (18-25). She had stage 5 breast development and stage 5 pubic hair. Her visual fields were full to confrontation.
Investigations:
serum cortisol (09.00 h)416 nmol/L (200-700) serum oestradiol51 pmol/L (200-400)
serum follicle-stimulating hormone0.8 U/L (2.5-10.0) serum luteinising hormone1.2 U/L (2.5-10.0) serum thyroid-stimulating hormone1.2 mU/L (0.4-5.0) serum free T415.6 pmol/L (10.0-22.0)
What is the most appropriate next investigation?
A. short tetracosactide (Synacthen@) test
B. karyotyping
C. serum prolactin
D. serum insulin-like growth factor 1
E. luteinising hormone-releasing hormone test
正解：C

質問 3：
A 32-year-old man presented with persistent thirst. He had a past history of polydactyly, which had been corrected surgically in infancy. His family had remarked about his recent weight gain. His only concern was of blurring of vision and difficulty reading. His father and paternal grandfather had each developed type 2 diabetes mellitus when aged 41 and 56 years, respectively.
His body mass index was 34 kg/m2 (18-25). Urinalysis showed glucose 2+, ketones 1+.
Investigations:
serum sodium142 mmol/L (137-144)
serum potassium3.8 mmol/L (3.5-4.9)
serum chloride105 mmol/L (95-107)
serum urea5.0 mmol/L (2.5-7.0)
serum creatinine90 umol/L (60-110)
haemoglobin A1c91 mmol/mol (20-42)
random plasma glucose11.3 mmol/L
ultrasound scan of kidneysnormal
What is the most likely underlying diagnosis?
A. monogenic diabetes caused by a mutation in the glucokinase gene
B. Bardet-Biedl syndrome
C. Prader-Willi syndrome
D. monogenic diabetes caused by a mutation in the HNF-1? gene
E. type 2 diabetes mellitus
正解：B

質問 4：
A 64-year-old man presented with palpitations, fatigue and malaise. Two months previously, he had sustained an acute myocardial infarction complicated by ventricular tachycardia and cardiac arrest, and had been discharged taking amiodarone 200 mg daily.
On examination, he appeared well, his pulse was 90 beats per minute and regular, and he
had mild tremor of his hands but no other abnormal signs.
Investigations:
serum thyroid-stimulating hormone6.2 mU/L (0.4-5.0)
serum free T418.2 pmol/L (10.0-22.0)
serum free T34.8 pmol/L (3.0-7.0)
What is the most appropriate next step in management?
A. isotope scan of thyroid
B. start levothyroxine
C. repeat thyroid function tests in 2 months
D. repeat thyroid function tests in 12 months
E. discontinue amiodarone
正解：C

質問 5：
A 17-year-old boy with a 7-year history of type 1 diabetes mellitus was transferred to the adolescent diabetes clinic. He had a history of poor clinic attendance. He admitted to having lost weight recently. His eyes had been photographed by a community ophthalmologist 1 week previously. A photograph of the right fundus is shown (see image).

Investigations:
haemoglobin A1c104 mmol/mol (20-42)
What is the most likely explanation for the retinal appearance?
A. preproliferative diabetic retinopathy
B. retinitis pigmentosa
C. benign choroidal naevus
D. drusen
E. macular oedema
正解：C

質問 6：
A 32-year-old woman presented at 34 weeks of pregnancy, after an episode of vaginal bleeding. Gestational diabetes had been diagnosed at 28 weeks and insulin was started at 29 weeks. Her pre-pregnancy body mass index was 32 kg/m2 (18-25) and there was no family history of diabetes. She was treated with betamethasone 12 mg over 2 days. She was taking 60 units of insulin subcutaneously daily (40 units prandial in three divided doses, and 20 units intermediate-acting insulin), which had been unchanged for 3 weeks.
On examination, she was apyrexial, her pulse was 96 beats per minute and her blood pressure was 124/74 mmHg. Urinalysis showed blood 1+, protein 1+, glucose 2+, ketones 3+.
Investigations:
serum sodium134 mmol/L (137-144)
serum potassium3.8 mmol/L (3.5-4.9)
serum chloride105 mmol/L (95-107) serum urea5.0 mmol/L (2.5-7.0) serum creatinine90 umol/L (60-110) random plasma glucose7.2 mmol/L
What is the most appropriate next step in management?
A. discharge and monitor blood glucose at home
B. continue to monitor blood glucose in hospital
C. start intravenous insulin
D. increase subcutaneous insulin doses by 2-4 units
E. measure venous bicarbonate
正解：E

質問 7：
A 34-year-old woman presented with palpitations, heat intolerance and a slight tremor. She was 9 weeks into her first pregnancy. She had not had any morning sickness.
On examination, her pulse was 100 beats per minute. She had a small uniform goitre but no tremor and no eye signs.
Investigations:
serum thyroid-stimulating hormone<0.01 mU/L (0.4-5.0)
serum free T442.0 pmol/L (10.0-22.0)
serum free T315.0 pmol/L (3.0-7.0)
anti-thyroid-stimulating hormone receptor
antibodies14 U/L (<7)
The decision was taken to treat her Graves' disease with propylthiouracil (PTU) rather than carbimazole.
What is the reason for this decision?
A. concordance with PTU is greater
B. PTU does not cross the placenta
C. PTU is less associated with agranulocytosis
D. PTU is less associated with hepatitis
E. PTU is less associated with aplasia cutis
正解：E

質問 8：
A 36-year-old woman was seen in the clinic with a recurrence of hyperthyroidism after a 2year remission. She had been treated with carbimazole for 18 months following her original presentation. She was moderately symptomatic and was keen to be treated in the same way again. She was planning a pregnancy.
Investigations: serum prolactin240 mU/L (<360) serum thyroid-stimulating hormone<0.1 mU/L (0.4-5.0) serum free T428.0 pmol/L (10.0-22.0)
anti-thyroid-stimulating hormone receptor antibodies44 U/L (<7)
What is the most appropriate next step in management?
A. block-and-replace treatment with carbimazole and levothyroxine
B. referral for thyroidectomy
C. radioiodine treatment
D. propylthiouracil
E. carbimazole
正解：D

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

1. A 27-year-old woman presented with a 6-month history of amenorrhoea and low mood. She complained of headaches but no visual disturbance. Her past medical history included anorexia nervosa but her current weight was stable.
On examination, her body mass index was 20.2 kg/m2 (18-25). Routine physical examination was normal and there was no galactorrhoea. Visual fields were full to confrontation.
Investigations:
serum cortisol (09.00 h)320 nmol/L (200-700)
short tetracosactide (Synacthen@) test (250 micrograms): serum cortisol (30 min after tetracosactide)630 nmol/L (>550) serum oestradiol200 pmol/L (200-400) plasma follicle-stimulating hormone2 U/L (2.5-10.0) plasma luteinising hormone4 U/L (2.5-10.0)
serum prolactin1001 mU/L (<360) serum free T418.0 pmol/L (10.0-22.0)
serum ?-human chorionic gonadotropin<5 U/L (<5)
What is the most appropriate next step in management?

A) start cabergoline 0.5 mg/week
B) pregnancy test
C) ultrasound scan of ovaries
D) MR scan of pituitary
E) encourage weight gain and reassess after 2 months

2. A 26-year-old woman was recovering from diabetic ketoacidosis and had been switched to her usual basal bolus insulin regimen. Her capillary blood glucose measurements during the day were high but fasting plasma glucose was in the range 5.0-7.0 mmol/L (3.0-6.0). She was drinking and eating normally.
On examination, her pulse was 76 beats per minute and her blood pressure was 106/66 mmHg. Urinalysis showed ketones 1+.
Investigations:
serum sodium143 mmol/L (137-144)
serum potassium4.4 mmol/L (3.5-4.9)
serum bicarbonate22 mmol/L (20-28)
serum creatinine72 umol/L (60-110)
plasma glucose 2 h after breakfast21 mmol/L
What is the most appropriate next step in management?

A) increase basal insulin at bed time
B) start glucose 5% with intravenous insulin
C) change to twice daily pre-mixed insulin
D) increase bolus insulin with meal
E) start variable-rate intravenous insulin infusion

3. A 52-year-old woman was referred to the clinic having lost 3-4 kg in weight over the previous 3 months. She also had palpitations and a sense of tremulousness. A diagnosis of thyrotoxicosis was confirmed by a blood test arranged by her general practitioner (GP).
Investigations (arranged by GP):
serum thyroid-stimulating hormone<0.01 mU/L (0.4-5.0)
serum free T435.8 pmol/L (10.0-22.0)
serum free T310.0 pmol/L (3.0-7.0)
On examination at her first clinic visit, she had a fine tremor, her pulse was 92 beats per minute and regular, and her eyes appeared normal. Her right thyroid lobe was moderately enlarged, and her left lobe was normal on examination. There was no associated lymphadenopathy. A technetium-99m thyroid isotope uptake scan was arranged (see image).

What is the most likely cause of her thyrotoxicosis?

A) Graves' disease
B) toxic multinodular goitre
C) toxic thyroid adenoma
D) factitious thyrotoxicosis
E) de Quervain's thyroiditis

4. A 32-year-old woman, with a 22-year history of type 1 diabetes mellitus, was seen in a pre-pregnancy diabetes clinic. She was a primigravida.
On examination, she had early background retinopathy, her blood pressure was 128/68 mmHg, and her body mass index was 29.7 kg/m2 (18-25).
Investigations:
haemoglobin A1c56 mmol/mol (20-42)
urinary albumin:creatinine ratio1.2 mg/mmol (<3.5)
Over the years her haemoglobin A1c concentration had varied between 58 and 69 mmol/mol. She had impaired awareness of hypoglycaemia and experienced approximately two severe hypoglycaemic events per year. She was worried about the risk of severe congenital malformations in her baby.
To what extent will the average risk of severe congenital malformation be increased in infants born to this mother with pregestational diabetes?

A) eight-fold
B) ten-fold
C) two-fold
D) six-fold
E) four-fold

5. A 26-year-old man was referred from the sexual health clinic, after small testes had been noted during treatment for genital warts. The patient reported recent loss of libido but there was no history of erectile dysfunction or delayed pubertal development. He was taking no regular medication. Approximately 3 years before presentation, he had taken anabolic steroids for 6 months to improve his muscle bulk.
On examination, normal facial, axillary and pubic hair was present. Testicular volume was 6 mL and his testes were firm.
Investigations:
serum testosterone4.0 nmol/L (9.0-35.0)
plasma follicle-stimulating hormone21.0 U/L (1.0-7.0)
plasma luteinising hormone23.0 U/L (1.0-10.0)
serum prolactin420 mU/L (<360)
What is the most likely diagnosis?

A) Klinefelter's syndrome
B) haemochromatosis
C) Kallmann's syndrome
D) microprolactinoma
E) exogenous anabolic steroid use

質問と回答：

質問 # 1
正解： D

質問 # 2
正解： D

質問 # 3
正解： A

質問 # 4
正解： C

質問 # 5
正解： A