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MRCPUK SEND 問題集

SEND

試験コード:SEND

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

最近更新時間:2025-03-27

問題と解答:全200問

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質問 1:
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 2:
A 34-year-old woman with a 21-year history of type 1 diabetes mellitus had started treatment with subcutaneous insulin pump therapy 18 months previously. Her haemoglobin A1c before starting pump therapy was 77 mmol/mol (20-42) and she had experienced severe hypoglycaemic events without warning symptoms over the previous 4 years.
At review in clinic, she reported continuing episodes of severe hypoglycaemia without warning symptoms despite regular monitoring and advice from her insulin pump nurse specialist.
On examination, her blood pressure was 134/80 mmHg and fundoscopy revealed moderate background diabetic retinopathy. Examination of the feet revealed strong, palpable pedal pulses and early evidence of sensory neuropathy.
Investigations:
estimated glomerular filtration rate (MDRD)24 mL/min/1.73 m2 (>60)
haemoglobin A1c56 mmol/mol (20-42)
24-h urinary total protein2.3 g (<0.2)
What is the most appropriate next step in management?
A. change to intensified subcutaneous insulin injections
B. refer for allogeneic pancreas transplantation
C. refer for continuous glucose monitoring
D. refer for allogeneic pancreatic islet cell transplantation
E. refer for combined pancreas and kidney transplantation
正解:E

質問 3:
A 24-year-old man was referred for investigation of infertility. He had been having unprotected intercourse with his partner for 18 months, but the couple had failed to conceive. He had been treated for Hodgkin's lymphoma at the age of 17.
What is the most appropriate investigation?
A. serum follicle-stimulating hormone
B. semen analysis
C. testicular biopsy
D. serum inhibin
E. serum testosterone
正解:B

質問 4:
A 54-year-old man on the neurosurgery unit developed hyponatraemia 3 days after presenting with a significant head injury. His Glasgow coma score (GCS) had been 6 on admission.
On examination, his GCS was 12. His blood pressure was 124/84 mmHg. There was no
oedema.
Investigations:
serum sodium118 mmol/L (137-144)
serum urea3.0 mmol/L (2.5-7.0)
serum creatinine72 umol/L (60-110)
random serum cortisol (08.00 h on day of review)480 nmol/L
serum thyroid-stimulating hormone1.2 mU/L (0.4-5.0)
random urinary sodium60 mmol/L
What is the most appropriate interpretation of these data?
A. the urinary sodium concentration is diagnostic of cerebral salt wasting
B. a short tetracosactide (Synacthen@) test (250 micrograms) is required to exclude secondary hypoadrenalism
C. they are consistent with syndrome of inappropriate antidiuresis
D. the diagnosis would be helped by measurement of plasma vasopressin concentration
E. intravascular volume depletion
正解:C

質問 5:
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. omega-3-acid ethyl esters
B. simvastatin
C. ezetimibe
D. fenofibrate
E. metformin
正解:B

質問 6:
A 34-year-old woman with Addison's disease reported four adrenal crises over the preceding 6 months, requiring hospital admission and intravenous administration of hydrocortisone. At outpatient follow-up, she was taking hydrocortisone 15 mg in the morning and 10 mg at midday, and fludrocortisone 50 micrograms daily.
What is the most important next step in management to prevent further crises?
A. increase dosage of hydrocortisone
B. change to sustained-release hydrocortisone
C. measure plasma adrenocorticotropic hormone
D. measure plasma renin
E. measure post-dose 09.00 h cortisol
正解:D

質問 7:
A 33-year-old woman was seen for diabetes review 2 months after her first pregnancy. Diabetes mellitus had been diagnosed at 18 weeks' gestation. She had experienced no symptoms; routine urinalysis had shown glucose 4+, with no ketones, and her fasting blood glucose concentration was 6.2 mmol/L (3.0-6.0), rising to 13.5 mmol/L (<7.8) in a 75-g oral glucose tolerance test. She had been treated with insulin during the pregnancy, and stopped after delivery. Her mother and maternal aunt had been treated for type 2 diabetes mellitus, and a maternal uncle for type 1 diabetes. Her body mass index was 23.7 kg/m2 (18-25).
Without insulin she remained well, with no osmotic symptoms, no weight loss and no ketosis.
Investigations:
fasting plasma glucose8.4 mmol/L (3.0-6.0)
haemoglobin A1c68 mmol/mol (20-42)
oral glucose tolerance test (75 g):
fasting plasma glucose7.9 mmol/L (3.0-6.0)
2-h plasma glucose13.8 mmol/L (<7.8)
serum insulin72 pmol/L (<186)
serum C-peptide945 pmol/L (180-360)
A trial of therapy with gliclazide 40 mg once daily led to a significant improvement in her blood glucose.
What is the most likely cause of her diabetes?
A. type 1 diabetes mellitus
B. latent autoimmune diabetes in adulthood
C. maturity-onset diabetes of the young caused by HNF-1? mutation
D. type 2 diabetes mellitus
E. maturity-onset diabetes of the young caused by glucokinase mutation
正解:C

質問 8:
A 47-year-old nuclear physics professor was referred for advice before taking up an overseas position, overseeing the dismantling of a reactor at the site of a recent nuclear accident. She stated that she would face a small risk of being exposed to significant radioactive contamination during her work and was concerned about her future risk of thyroid cancer.
What is the most appropriate advice?
A. no precautions are necessary for people aged 40 years or over
B. take potassium iodide tablets
C. wear lead neck shield while outdoors
D. take selenium tablets
E. avoid consuming local milk and vegetables
正解:B

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

1. A 27-year-old woman with type 1 diabetes mellitus was invited to attend a structured education (e.g. DAFNE) coursE.
Which quality of life domain is most affected when a person is found to have type 1 diabetes mellitus?

A) sex life
B) enjoyment of leisure activities
C) freedom to eat as one wishes
D) family life
E) working life and work-related opportunities


2. A 35-year-old woman with a 12-year history of type 1 diabetes mellitus was reviewed in the multidisciplinary pump clinic, because her diabetes was treated with an insulin pump. She had a group 2, C1 lorry-driving licence.
Specific driving-related questioning showed that she kept fast-acting carbohydrate in her vehicles and she reported good hypoglycaemic warnings. Data downloaded from her pump indicated significant variability in her blood glucose readings with few results below 2 mmol/L. She declared that this happened occasionally and she was able to explain the events.
According to implementation by the UK of the Third European Union Directive on driving, what is the most appropriate advice?

A) she must surrender her licence for 6 months
B) her licence must be surrendered immediately until further assessment
C) she can continue to drive
D) she must appear before a Driver and Vehicle Licensing Agency-accredited diabetes specialist for assessment within 1 month
E) she should stop driving voluntarily until blood glucose levels increase


3. A 43-year-old man was in an ENT ward, having recently undergone removal of a carotid body tumour.
Five years previously, he had undergone a similar procedure in another hospital. He also recalled that his brother had undergone surgery for a similar condition, and that his father, who had since died, might also have had neck surgery.
The ENT surgeons were concerned that there might be an underlying genetic diagnosis.
What is the most likely diagnosis?

A) neurofibromatosis type 1
B) multiple endocrine neoplasia type 2
C) succinate dehydrogenase D deficiency
D) succinate dehydrogenase A deficiency
E) von Hippel-Lindau disease


4. A 62-year-old woman was admitted with right lower lobe pneumonia. She was taking
amiodarone for atrial fibrillation. Routine thyroid function tests were performed.
Investigations:
serum thyroid-stimulating hormone0.3 mU/L (0.4-5.0)
serum free T427.0 pmol/L (10.0-22.0)
serum free T34.2 pmol/L (3.0-7.0)
anti-thyroid peroxidase antibodies32 IU/mL (<50)
What is the most appropriate interpretation of the thyroid function tests?

A) amiodarone-induced thyrotoxicosis type II
B) amiodarone-induced thyrotoxicosis type I
C) subclinical amiodarone-induced thyrotoxicosis
D) amiodarone effect in a euthyroid patient
E) Wolff-Chaikoff effect


5. A 77-year-old woman presented with a 10-week history of facial hirsutism, scalp hair loss and deepening of the voice.
On examination, her body mass index was 32 kg/m2 (18-25). Her blood pressure was 164/94 mmHg. She had coarse terminal hairs on her upper lip and beard areas. Abdominal examination was normal, but she refused examination of her external genitalia.
Investigations:
serum sodium144 mmol/L (137-144) serum potassium3.6 mmol/L (3.5-4.9) serum urea7.7 mmol/L (2.5-7.0) serum creatinine122 umol/L (60-110) fasting plasma glucose6.4 mmol/L (3.0-6.0) serum testosterone17.2 nmol/L (0.5-3.0) serum luteinising hormone2.2 U/L (>30.0)
What is the most appropriate initial investigation?

A) overnight dexamethasone suppression test (after 1 mg dexamethasone)
B) plasma adrenocorticotropic hormone and serum cortisol
C) serum dehydroepiandrosterone sulphate
D) CT scan of abdomen and pelvis
E) serum oestradiol


質問と回答:

質問 # 1
正解: C
質問 # 2
正解: C
質問 # 3
正解: C
質問 # 4
正解: D
質問 # 5
正解: D

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