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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 62-year-old woman with persistent hypertension attended the clinic for review. She had no previous medical history of note and was taking amlodipine, ramipril, bendroflumethiazide, spironolactone and doxazosin. 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)
A blood test for renin and aldosterone concentration was being considered.
For what minimum period should spironolactone be discontinued before this test?

A) 72 h
B) 8 weeks
C) 2 weeks
D) 1 week
E) 6 weeks

2. 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) latent autoimmune diabetes in adulthood
B) maturity-onset diabetes of the young caused by glucokinase mutation
C) type 1 diabetes mellitus
D) maturity-onset diabetes of the young caused by HNF-1? mutation
E) type 2 diabetes mellitus

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) strontium ranelate
D) sodium clodronate
E) risedronate sodium

4. An 18-year-old man presented to the thyroid clinic complaining of a lump in his neck that had been present for 9 weeks. It was not painful. At the age of 12, he had developed acute lymphoblastic leukaemia and had undergone a bone marrow transplant preceded by total body irradiation and cyclophosphamide.
On examination, he was euthyroid. There was a 1.5-cm firm mass on the left side of the neck, which moved when he swallowed.
Investigations:
serum thyroid-stimulating hormone1.9 mU/L (0.4-5.0)
serum free T416.8 pmol/L (10.0-22.0)
What is the most appropriate initial course of action?

A) technetium-99m scintigraphy scan of thyroid
B) ultrasound-guided fine-needle aspiration of the nodule
C) surgical referral for hemithyroidectomy
D) CT scan of neck and thorax
E) FDG-PET-CT scan

5. A 62-year-old woman was referred with difficulty in swallowing and a painful, swollen neck.
On examination, her neck was tender to palpation with a small, diffuse goitre. There was no
associated neck lymphadenopathy.
Investigations:
serum thyroid-stimulating hormone<0.04 mU/L (0.4-5.0)
serum free T426.0 pmol/L (10.0-22.0)
serum free T312.0 pmol/L (3.0-7.0)
What is the most likely diagnosis?

A) haemorrhage into a thyroid cyst
B) thyroid carcinoma
C) toxic adenoma
D) Graves' disease
E) subacute thyroiditis

質問と回答：