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

1. A 17-year-old boy had panhypopituitarism, including diabetes insipidus, following treatment for a craniopharyngioma. He was taking appropriate replacement therapy. In the transition clinic, he was keen to continue growth hormone replacement therapy following a 12-month break after reaching final height.
Which is the most appropriate test to assess his growth hormone status?

A) growth hormone day profile
B) insulin-like growth factor 1
C) clonidine test
D) insulin-like growth factor-binding protein 3
E) insulin tolerance test

2. A 34-year-old man was referred to the diabetes outpatient clinic with impaired glucose tolerance. He had a family history of diabetes mellitus and had a body mass index of 34.6 kg/m2 (18-25).
On examination, his blood pressure was 140/82 mmHg.
He wished to delay the onset of frank diabetes mellitus.
What is the most effective way of achieving this outcome?

A) orlistat
B) lifestyle changes aimed at weight loss
C) metformin
D) acarbose
E) ramipril

3. A 32-year-old man presented to the emergency department after becoming acutely unwell. He had a 5-year history of type 1 diabetes mellitus and no other significant medical history.
On examination, he was apyrexial, his pulse was 120 beats per minute, his blood pressure was 96/58 mmHg and his respiratory rate was 32 breaths per minute.
Investigations:
random plasma glucose14.2 mmol/L
arterial blood gases, breathing 60% oxygen:
PO28.9 kPa (11.3-12.6)
PCO22.6 kPa (4.7-6.0)
pH7.10 (7.35-7.45)
H+79 nmol/L (35-45)
bicarbonate6.1 mmol/L (21-29)
base excess-18 mmol/L (+-2)
What diagnosis is most likely to account for these results?

A) diabetic ketoacidosis
B) acute myocardial infarction
C) acute asthma
D) diabetic ketoacidosis and pulmonary embolism
E) salicylate poisoning

4. An 18-year-old woman was referred by her general practitioner for further investigation of "funny turns" during which she developed palpitations, sweating, tremor, hunger, anxiety and paraesthesiae; all of these symptoms were relieved immediately by a sugary drink. She was otherwise well and was not taking any regular medication. There was a family history of type 1 diabetes mellitus. A spontaneous hypoglycaemic episode had not been captured and she was admitted to the diabetes/endocrine ward for a 72-hour fast. Her renal function was normal.
After a 12-hour fast she experienced her typical symptoms. Urinalysis showed no urinary ketones.
Investigations after 12-h fast:
fasting plasma glucose 2.0 mmol/L (3.0-6.0)
plasma insulin56 pmol/L (<21 after hypoglycaemia)
serum C-peptide514 pmol/L (180-360)
What is the most appropriate next step in management?

A) obtain a careful history looking for access to exogenous insulin
B) MR scan of abdomen and pelvis to localise a mesenchymal tumour producing insulin-like growth factor 2
C) request a urinary sulphonylurea screen on sample obtained during the fast
D) MR scan of pancreas to localise an insulinoma
E) coeliac axis angiography

5. A 23-year-old woman was found to have type 1 diabetes mellitus following a short history of polyuria, polydipsia and unintentional weight loss. She started taking insulin aspart before meals and insulin detemir daily.
What is the most appropriate time from diagnosis to start screening for microalbuminuria?

A) immediately
B) 10 years
C) 1 year
D) 5 years
E) 2 years

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