最新のSEND問題集で試験を準備する

MRCPUK SEND 試験概要:

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

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 referral to an ophthalmologist
B) urgent re-screen within 2 weeks
C) routine re-screen in 6 months
D) routine re-screen in 12 months
E) urgent referral to an ophthalmologist within 2 weeks

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

3. A 55-year-old man presented with a 3-year history of increasing pain in the right hip. He had been otherwise well and was taking no medication. He was reluctant to consider any intravenous treatment as he had a phobia of needles.
Investigations:
X-ray of hipssclerotic bone in right pubis and ischium
suggestive of Paget's disease
What is the most appropriate oral treatment?

A) ibandronate sodium
B) calcium and vitamin D
C) risedronate sodium
D) strontium ranelate
E) sodium clodronate

4. A 26-year-old man with type 1 diabetes mellitus attended a carbohydrate-counting course to facilitate tighter glucose control. He estimated that his carbohydrate ratio was 1:10 and 1 unit correction dose reduced his glucose by 3.0 mmol/L.
He planned to eat a meal containing 50 g of carbohydrate. His pre-meal glucose was 16.0 mmol/L with a target blood glucose of 7.0 mmol/L.
What is the correct dose of bolus insulin (units) that he should administer?

A) 2
B) 8
C) 10
D) 6
E) 4

5. An 18-year-old man, whose ambition was to become a member of the elite armed forces, presented with gynaecomastia. His weekly alcohol consumption was 35 units.
On examination, he had normal secondary sexual characteristics, a well-developed, muscular physique and modest, slightly tender bilateral gynaecomastia. Testes were 10 mL with soft texture.
Investigations:
haemoglobin160 g/L (130-180)
MCV96 fL (80-96)
serum dehydroepiandrosterone sulphate4 umol/L (2-10)
serum oestradiol180 pmol/L (<180)
serum testosterone (09.00 h)6.0 nmol/L (9.0-35.0)
plasma follicle-stimulating hormone1.0 U/L (1.0-7.0)
plasma luteinising hormone0.7 U/L (1.0-10.0)
serum prolactin420 mU/L (<360)
What is the most likely diagnosis?

A) alcohol excess
B) persistence of pubertal gynaecomastia
C) androgen abuse
D) oestrogen-secreting testicular tumour
E) primary hypogonadotrophic hypogonadism

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