MRCPUK Endocrinology and Diabetes (Specialty Certificate Examination) : SEND

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

1. A 46-year-old man of European descent was reviewed in the diabetes clinic. He had type 2 diabetes mellitus, which had been diagnosed 6 months previously. He had been symptom free and was a non-smoker but had a family history of cardiovascular disease. He exercised regularly and had managed to lose 8 kg.
On examination, his blood pressure was 148/76 mmHg, his weight was 76 kg and his body mass index was 24 kg/m2 (18-25).
Investigations:
urinary albumin:creatinine ratio0.6 mg/mmol (<2.5)
serum cholesterol5.6 mmol/L (<5.2)
serum HDL cholesterol0.90 mmol/L (>1.55)
fasting serum triglycerides2.20 mmol/L (0.45-1.69)
According to NICE guidelines (CG181, July 2014), what is the most appropriate management of his lipid profile?

A) start nicotinic acid
B) start a fibrate
C) start a statin
D) assess cardiovascular risk using UKPDS risk engine
E) observe and repeat lipid profile in a few months

2. A 53-year-old man with a history of sweats and tremor was found to have abnormal thyroid function tests and a small diffuse goitre. He was treated with carbimazole 20 mg but developed a sore throat after 3 weeks.
Investigations:
haemoglobin150 g/L (130-180)
white cell count2.0 ? 109/L (4.0-11.0)
neutrophil count0.4 ? 109/L (1.5-7.0)
serum thyroid-stimulating hormone<0.02 mU/L (0.4-5.0)
serum free T429.0 pmol/L (10.0-22.0)
thyrotropin receptor antibodiespositive
The carbimazole was stopped; his sore throat resolved and the full blood count normalised.
What is the most appropriate next step in management?

A) early partial thyroidectomy
B) early radioactive iodine therapy
C) start propylthiouracil 100 mg twice daily
D) restart carbimazole 5 mg daily
E) treat with Lugol's iodine 5 drops three times daily for 6 months

3. A 32-year-old man presented with persistent thirst. He had a past history of polydactyly, which had been corrected surgically in infancy. His family had remarked about his recent weight gain. His only concern was of blurring of vision and difficulty reading. His father and paternal grandfather had each developed type 2 diabetes mellitus when aged 41 and 56 years, respectively.
His body mass index was 34 kg/m2 (18-25). Urinalysis showed glucose 2+, ketones 1+.
Investigations:
serum sodium142 mmol/L (137-144)
serum potassium3.8 mmol/L (3.5-4.9)
serum chloride105 mmol/L (95-107)
serum urea5.0 mmol/L (2.5-7.0)
serum creatinine90 umol/L (60-110)
haemoglobin A1c91 mmol/mol (20-42)
random plasma glucose11.3 mmol/L
ultrasound scan of kidneysnormal
What is the most likely underlying diagnosis?

A) monogenic diabetes caused by a mutation in the glucokinase gene
B) Bardet-Biedl syndrome
C) Prader-Willi syndrome
D) monogenic diabetes caused by a mutation in the HNF-1? gene
E) type 2 diabetes mellitus

4. A 48-year-old woman presented with a 2-year history of weight gain, easy bruising and
mood disturbance.
Investigations:
fasting plasma glucose6.9 mmol/L (3.0-6.0)
low-dose dexamethasone suppression test (2 mg/day for 48 h):
serum cortisol200 nmol/L (<50)
24-h urinary free cortisol (?3)670, 400 and 300 nmol (55-250)
plasma adrenocorticotropic hormone (09.00 h)25.0 pmol/L (3.3-15.4)
MR scan of pituitarynormal
What test is most likely to give a definitive diagnosis?

A) petrosal sinus sampling
B) CT scan of chest
C) octreotide scan
D) corticotropin-releasing hormone test
E) high-dose dexamethasone suppression text (8 mg/day for 48 h)

5. A 49-year-old woman presented with a slowly enlarging lump in her neck.
On examination, there was a 3.5-cm firm nodule in the left lobe of the thyroid gland, with no associated lymphadenopathy.
Investigations:
serum thyroid-stimulating hormone<0.05 mU/L (0.4-5.0)
serum free T426.0 pmol/L (10.0-22.0)
serum free T38.6 pmol/L (3.0-7.0)
An ultrasound scan showed an enlarged thyroid gland, with small nodules throughout. There was a larger hypoechoic 3.3-cm nodule with increased intranodular vascularity in the lower pole of the left lobe, with no associated lymphadenopathy.
What is the most appropriate management?

A) core biopsy of the thyroid nodule
B) isotope uptake scan
C) radioactive iodine treatment
D) fine-needle aspiration of the nodule
E) partial thyroidectomy

質問と回答：