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最新的 MRCPUK Certification SEND 免費考試真題:

1. A 58-year-old man was referred to the endocrine clinic after a CT scan of abdomen had shown a 4.5-cm left adrenal mass, with a Hounsfield unit measurement of 11 (consistent with high lipid content). He had a 10-year history of type 2 diabetes mellitus and was taking metformin. He was also taking atenolol for hypertension.
On examination at the clinic, his blood pressure was 162/94 mmHg. He was centrally obese with a body mass index of 27 kg/m2 (18-25).
Investigations:
serum potassium3.9 mmol/L (3.5-4.9)
plasma renin activity (after 30 min upright)1.0 pmol/mL/h (3.0-4.3)
plasma aldosterone (after 4 h upright)680 pmol/L (330-830)
overnight dexamethasone suppression test (after 1 mg dexamethasone):
serum cortisol164 nmol/L (<50)
24-h urinary free cortisol132 nmol (55-250)
24-h urinary catecholamines
(adrenaline and noradrenaline)normal
As the lesion was >4 cm in diameter, laparoscopic adrenalectomy was recommended.
What is the most appropriate advice to give to the surgical team about perioperative
management?

A) no special precautions are required
B) give preoperative ?-adrenergic receptor blockade in case the lesion is an occult phaeochromocytoma
C) short tetracosactide (Synacthen@) test 48 h postoperatively
D) give corticosteroid cover during and after surgery and reassess postoperatively
E) measure cortisol and aldosterone 2 weeks postoperatively

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

3. A 23-year-old barmaid presented with headache, sweating and collapse. She had a past medical history of tension headache and unexplained abdominal pain. Her regular medication included amitriptyline 25 mg at night and paracetamol 1 g as required. She was a smoker and regularly drank alcohol.
On examination, her pulse was 120 beats per minute and her blood pressure was 210/128 mmHg.
Investigations:
24-h urinary metanephrine5.4 umol (<2)
24-h urinary normetanephrine15.2 umol (<3) What substance is most likely to cause assay interference in the measurement of urinary metanephrines?

A) paracetamol
B) amitriptyline
C) caffeine
D) nicotine
E) alcohol

4. 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) ramipril
C) metformin
D) lifestyle changes aimed at weight loss
E) acarbose

5. A 43-year-old woman was admitted with right lower lobe pneumonia and was found to have atrial fibrillation. She had a history of bipolar disorder for which she was taking lithium. Her menstrual periods were normal.
Investigations on admission:
serum thyroid-stimulating hormone (TSH)0.98 mU/L (0.4-5.0)
serum free T428.1 pmol/L (10.0-22.0)
serum free T314.2 pmol/L (3.0-7.0)
Assay interference had been excluded.
Subsequent investigations:
serum sex hormone binding globulin64 nmol/L (40-137)
serum thyroid-hormone receptor ?-subunit0.8 IU/L (<1.0)
anti-thyroid peroxidase antibodiesnegative
What is the most likely diagnosis?

A) thyroid hormone resistance
B) lithium-induced hyperthyroidism
C) TSHoma
D) surreptitious ingestion of thyroxine
E) non-thyroidal illness (sick euthyroid syndrome)

問題與答案：

問題 #1 答案： D

問題 #2 答案： B

問題 #3 答案： A

問題 #4 答案： D

問題 #5 答案： A