MRCPUK SEND

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

1. A 15-year-old boy was referred by the school nurse because she was concerned about his weight. There was no past history of note. He was not taking any medication. His height was 1.61 m and he weighed 70.5 kg.
Investigations: growth chartsee image

What is the most likely diagnosis?

A) Prader-Willi syndrome
B) simple obesity
C) leptin deficiency
D) Cushing's disease
E) growth hormone deficiency

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

3. A 56-year-old man attended routine follow-up for treatment of hypogonadism of late onset. His only medication was testosterone undecanoate (1 g intramuscular injection, every 12 weeks). He had started this treatment 12 months previously and last received the injection 1 week before review.
Digital rectal examination was normal.
Investigations (baseline): haemoglobin145 g/L (130-180) haematocrit0.46 (0.40-0.52) serum prostate-specific antigen0.6 ug/L (<4)
Investigations (12 months after treatment):
haemoglobin153 g/L (130-180) haematocrit0.51 (0.40-0.52) serum prostate-specific antigen5.1 ug/L (<4)
What is the most appropriate next step in management?

A) decrease testosterone injection frequency to 14 weeks
B) stop testosterone therapy
C) refer for urological assessment
D) reassure and repeat blood tests in 12 months
E) check serum testosterone

4. A 25-year-old woman with type 1 diabetes mellitus was admitted to hospital with a 12-hour
history of nausea and lethargy.
On examination, her temperature was 37.5C, she was dehydrated and her Glasgow coma
score was 14. Urinalysis showed glucose 2+, ketones 3+, protein negative.
Investigations:
white cell count12.0 ? 109/L (4.0-11.0)
neutrophil count8.0 ? 109/L (1.5-7.0)
random plasma glucose22.0 mmol/L
arterial blood gases, breathing air:
pH7.20 (7.35-7.45)
serum C-reactive protein12 mg/L (<10)
She was treated with intravenous sodium chloride 0.9% and fixed-rate intravenous insulin
infusion, and initially improved. Twelve hours into her admission, she complained of a
headache.
On examination, her temperature was 37.3C and her Glasgow coma score was 15. Her
pulse was 85 beats per minute and her blood pressure was 110/70 mmHg. There was no
neck stiffness, papilloedema or focal neurological signs.
What is the most likely cause for her headache?

A) tension headache
B) sagittal sinus thrombosis
C) bacterial meningitis
D) viral encephalitis
E) cerebral oedema

5. A 17-year-old boy was concerned about his height. He had been treated for Crohn's disease since the age of 13 with a combination of topical and systemic corticosteroids and azathioprine. He was currently taking mercaptopurinE.
On examination, his height was on the 25th centile.
Investigations:
X-ray of right kneesee image

What is the most appropriate next step in management?

A) refer for leg lengthening surgery
B) investigate for growth hormone deficiency
C) advise him that he will continue to grow for 12 months
D) advise him that growth is complete
E) treat with growth hormone

質問と回答：