MRCPUK SEND 問題集

質問 1：
A 76-year-old man with a 17-year history of type 2 diabetes mellitus attended for his annual review. Comparison of his retinal screening report with the previous year's report showed that his visual acuity was unchanged at 6/9 in both eyes. The previous year's right eye retinal image had been reported as 'pre-proliferative retinopathy', whereas this year's was reported as 'pre-proliferative retinopathy with maculopathy'.
What is the most appropriate next step?
A. routine re-screen in 6 months
B. routine referral to an ophthalmologist
C. urgent referral to an ophthalmologist within 2 weeks
D. urgent re-screen within 2 weeks
E. routine re-screen in 12 months
正解：B

質問 2：
A 26-year-old physiologist was seen in the diabetes outpatient clinic. She had type 1 diabetes mellitus of 9 months' duration, treated with subcutaneous insulin.
She asked what symptoms of hypoglycaemia she might experience.
In what order are responses to hypoglycaemia most likely to occur as blood glucose falls?
A. neuroglycopenia, autonomic, counter-regulatory hormones
B. counter-regulatory hormones, autonomic, neuroglycopenia
C. autonomic, neuroglycopenia, counter-regulatory hormones
D. autonomic, counter-regulatory hormones, neuroglycopenia
E. counter-regulatory hormones, neuroglycopenia, autonomic
正解：B

質問 3：
A 55-year-old dental nurse was referred for bone densitometry after sustaining a non-displaced fracture of the femur after falling down a step. She had experienced no other fractures. Her only medical problem was long-standing anaemia of unknown cause. The only family history was of persistent dental abscesses affecting her father. She had three children who were well. She was taking no medication.
Examination was normal.
Investigations:
haemoglobin102 g/L (115-165)
MCV85 fL (80-96)
white cell count6.0 ? 109/L (4.0-11.0)
platelet count245 ? 109/L (150-400)
erythrocyte sedimentation rate25 mm/1st h (<30)
serum creatinine85 umol/L (60-110)
serum corrected calcium2.40 mmol/L (2.20-2.60)
serum alkaline phosphatase56 U/L (45-105)
DXA scan spine (L2-L4)T score +5.8
DXA scan total hipT score +5.4
What is the most likely diagnosis?
A. high bone mass phenotype
B. myelodysplasia
C. osteopetrosis
D. Paget's disease
E. fluorosis
正解：C

質問 4：
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
正解：D

質問 5：
A 64-year-old man attended the diabetes clinic for annual review. He complained of very recent tingling in his feet. A monofilament was used to screen for the presence of chronic sensorimotor diabetic peripheral neuropathy.
What force should a monofilament deliver?
A. 1 g
B. 5 g
C. 2 g
D. 20 g
E. 10 g
正解：E

質問 6：
A 64-year-old man, who was undergoing investigation for altered bowel habit, was referred to the endocrine clinic after a CT scan of abdomen had shown a 4-cm mass in his left adrenal gland. He had a history of hypertension and type 2 diabetes mellitus.
Investigations:
low-dose dexamethasone suppression test (2 mg/day for 48 h):
serum cortisol350 nmol/L (<50)
24-h urinary free cortisol400 nmol (55-250)
plasma adrenocorticotropic hormone (09.00 h)2.0 pmol/L (3.3-15.4)
He underwent laparoscopic removal of his left adrenal gland.
How should his endocrine condition be managed following surgery?
A. 24-h urinary cortisol 6 weeks postoperatively and start hydrocortisone if abnormally low
B. tetracosactide (Synacthen@) test 6 weeks postoperatively and start hydrocortisone if abnormal
C. immediate postoperative tetracosactide (Synacthen@) test and, if abnormal, start hydrocortisone
D. start hydrocortisone perioperatively and continue until tetracosactide (Synacthen@) test in 6 weeks
E. introduce hydrocortisone and fludrocortisone postoperatively according to blood pressure and electrolytes
正解：D

質問 7：
A 32-year-old woman presented to the outpatient clinic with a 1-year history of amenorrhoea that began after stopping her oral contraceptive pill. She had previously had two successful pregnancies and was otherwise well.
Examination was normal and no visual field defect was present on testing to confrontation.
Investigations:
serum sodium138 mmol/L (137-144) serum potassium3.8 mmol/L (3.5-4.9) plasma follicle-stimulating hormone2.0 U/L (2.5-10.0) plasma luteinising hormone2.0 U/L (2.5-10.0) serum prolactin1050 mU/L (<360)
MR scan of pituitarysee image

What is the most appropriate treatment?
A. octreotide
B. stereotactic pituitary radiosurgery
C. cabergoline
D. pituitary surgery
E. bromocriptine
正解：D

質問 8：
A 76-year-old woman with type 2 diabetes mellitus was reviewed. Treatment with thiazolidinedione was being considered, but she was worried about the effect this medication might have on the incidence of complications. She had known background retinopathy.
What complication is more likely to worsen in a patient taking a thiazolidinedione?
A. retinal vein thrombosis
B. hard exudates
C. cataract
D. retinal haemorrhages
E. macular oedema
正解：E