최신 SEND 무료덤프 - MRCPUK Endocrinology and Diabetes (Specialty Certificate Examination)
A 20-year-old man presented with a 6-month history of lethargy and weakness. His brother had been found to have adrenal failure at the age of 18. He had two sisters who were well and there was no other family history of endocrine autoimmune disease.
On examination, his blood pressure was 100/60 mmHg.
Investigations:
serum sodium136 mmol/L (137-144)
serum potassium4.8 mmol/L (3.5-4.9)
short tetracosactide (Synacthen@) test (250 micrograms):
baseline serum cortisol100 nmol/L
serum cortisol (30 min after tetracosactide)250 nmol/L (>550)
anti-adrenal antibodiesnegative
What is the most important diagnosis to consider?
On examination, his blood pressure was 100/60 mmHg.
Investigations:
serum sodium136 mmol/L (137-144)
serum potassium4.8 mmol/L (3.5-4.9)
short tetracosactide (Synacthen@) test (250 micrograms):
baseline serum cortisol100 nmol/L
serum cortisol (30 min after tetracosactide)250 nmol/L (>550)
anti-adrenal antibodiesnegative
What is the most important diagnosis to consider?
정답: A
A 30-year-old man was reviewed in the diabetes clinic. He had type 1 diabetes mellitus of 6 months' duration, treated with subcutaneous insulin in a basal bolus regimen (short-acting insulin three times daily; long-acting insulin once daily).
Investigations:
haemoglobin A1c52 mmol/mol (20-42)
At what arterialised venous blood glucose threshold would a patient typically expect to develop neuroglycopenic symptoms?
Investigations:
haemoglobin A1c52 mmol/mol (20-42)
At what arterialised venous blood glucose threshold would a patient typically expect to develop neuroglycopenic symptoms?
정답: E
A 52-year-old woman had been found to have type 2 diabetes mellitus approximately 6
months previously.
Investigations:
haemoglobin A1c50 mmol/mol (20-42)
What is the lifetime risk of her identical twin sister also developing type 2 diabetes mellitus?
months previously.
Investigations:
haemoglobin A1c50 mmol/mol (20-42)
What is the lifetime risk of her identical twin sister also developing type 2 diabetes mellitus?
정답: B
A 64-year-old man was reviewed in the diabetes clinic. He had a history of type 2 diabetes mellitus treated for 12 years. He had sustained a previous episode of acute kidney injury believed to be secondary to renal artery stenosis and exposure to an ACE inhibitor. He was being treated with metformin 500 mg three times daily and gliclazide 80 mg twice daily.
Investigations:
serum sodium143 mmol/L (137-144)
serum potassium4.4 mmol/L (3.5-4.9)
serum creatinine123 umol/L (60-110)
estimated glomerular filtration rate (MDRD)51 mL/min/1.73 m2 (>60)
haemoglobin A1c75 mmol/mol (20-42)
He required a third drug that would not require dose adjustment if renal function were to decline in the future.
What additional medication is most appropriate?
Investigations:
serum sodium143 mmol/L (137-144)
serum potassium4.4 mmol/L (3.5-4.9)
serum creatinine123 umol/L (60-110)
estimated glomerular filtration rate (MDRD)51 mL/min/1.73 m2 (>60)
haemoglobin A1c75 mmol/mol (20-42)
He required a third drug that would not require dose adjustment if renal function were to decline in the future.
What additional medication is most appropriate?
정답: E
A 28-year-old Asian woman was seen in the joint diabetes-antenatal clinic at 16 weeks' gestation. She gave a history of gestational diabetes during her previous pregnancy. She had a strong family history of diabetes mellitus. She was fit and well, and had no symptoms other than slight early morning sickness.
According to NICE guidance (NG3, February 2015) for management of pregnancy, what is the most appropriate way to screen for gestational diabetes in this woman?
According to NICE guidance (NG3, February 2015) for management of pregnancy, what is the most appropriate way to screen for gestational diabetes in this woman?
정답: C
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?
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?
정답: A
A 77-year-old woman presented with acute severe pain in the mid-thoracic spine after lifting a heavy bag of shopping. She had reported losing 6 cm in height over the preceding 5 years.
On examination, she was of slight build and experienced difficulty rising from a chair. There was tenderness in the region of T9/10.
Investigations:
plain thoracic X-ray of spinewedge fracture of T10
DXA scanT score -2.7 at L1-L4 and -2.3 at
the left total hip
What is the best estimate for the proportion of vertebral fractures that present clinically with back pain, as seen in this patient?
On examination, she was of slight build and experienced difficulty rising from a chair. There was tenderness in the region of T9/10.
Investigations:
plain thoracic X-ray of spinewedge fracture of T10
DXA scanT score -2.7 at L1-L4 and -2.3 at
the left total hip
What is the best estimate for the proportion of vertebral fractures that present clinically with back pain, as seen in this patient?
정답: C
A 35-year-old woman with a 12-year history of type 1 diabetes mellitus was reviewed in the multidisciplinary pump clinic, because her diabetes was treated with an insulin pump. She had a group 2, C1 lorry-driving licence.
Specific driving-related questioning showed that she kept fast-acting carbohydrate in her vehicles and she reported good hypoglycaemic warnings. Data downloaded from her pump indicated significant variability in her blood glucose readings with few results below 2 mmol/L. She declared that this happened occasionally and she was able to explain the events.
According to implementation by the UK of the Third European Union Directive on driving, what is the most appropriate advice?
Specific driving-related questioning showed that she kept fast-acting carbohydrate in her vehicles and she reported good hypoglycaemic warnings. Data downloaded from her pump indicated significant variability in her blood glucose readings with few results below 2 mmol/L. She declared that this happened occasionally and she was able to explain the events.
According to implementation by the UK of the Third European Union Directive on driving, what is the most appropriate advice?
정답: E
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?
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?
정답: B
A 36-year-old woman was referred to the endocrine clinic with abnormal thyroid function
tests. She gave a 3-year history of increased sweating and anxiety following an assault and, initially, her symptoms had been attributed to post-traumatic stress disorder.
Investigations:
serum thyroid-stimulating hormone (TSH)3.1 mU/L (0.4-5.0)
serum free T429.8 pmol/L (10.0-22.0)
serum free T33.5 pmol/L (3.0-7.0)
What is the most likely interpretation of her thyroid function test results?
tests. She gave a 3-year history of increased sweating and anxiety following an assault and, initially, her symptoms had been attributed to post-traumatic stress disorder.
Investigations:
serum thyroid-stimulating hormone (TSH)3.1 mU/L (0.4-5.0)
serum free T429.8 pmol/L (10.0-22.0)
serum free T33.5 pmol/L (3.0-7.0)
What is the most likely interpretation of her thyroid function test results?
정답: C