최신 MRCPUK Certification SEND 무료샘플문제:

1. A 34-year-old woman presented with palpitations, heat intolerance and a slight tremor. She was 9 weeks into her first pregnancy. She had not had any morning sickness.
On examination, her pulse was 100 beats per minute. She had a small uniform goitre but no tremor and no eye signs.
Investigations:
serum thyroid-stimulating hormone<0.01 mU/L (0.4-5.0)
serum free T442.0 pmol/L (10.0-22.0)
serum free T315.0 pmol/L (3.0-7.0)
anti-thyroid-stimulating hormone receptor
antibodies14 U/L (<7)
The decision was taken to treat her Graves' disease with propylthiouracil (PTU) rather than carbimazole.
What is the reason for this decision?

A) concordance with PTU is greater
B) PTU is less associated with aplasia cutis
C) PTU is less associated with agranulocytosis
D) PTU does not cross the placenta
E) PTU is less associated with hepatitis

2. A 46-year-old South Asian man presented with a 2-month history of dry mouth and polyuria. He had hypertension treated with bendroflumethiazide. There was no family history of diabetes mellitus, but his father had died suddenly during lower limb angioplasty at the age of 51.
On examination, the patient's pulse was 76 beats per minute and regular, and his blood pressure was 164/86 mmHg. The rest of the physical examination was normal. Urinalysis was normal.
Investigations:
serum sodium143 mmol/L (137-144)
serum potassium3.0 mmol/L (3.5-4.9)
serum creatinine123 umol/L (60-110)
fasting plasma glucose6.9 mmol/L (3.0-6.0)
What is the most appropriate next step in management?

A) haemoglobin A1c measurement
B) change bendroflumethiazide to ramipril
C) oral glucose tolerance test
D) start oral hypoglycaemic treatment
E) repeat fasting plasma glucose

3. A 48-year-old man presented with gynaecomastia. His serum oestradiol was increased and a CT scan of adrenal glands revealed a 13-cm tumour of the left adrenal gland. Further workup showed increased secretion of 17-hydroxyprogesterone, cortisol and androstenedione. A diagnosis of adrenocortical carcinoma was suspected.
Investigations:
staging CT scan of chest and abdomenno evidence of metastasis
What is the most appropriate next step in management?

A) iodocholesterol scan
B) left adrenalectomy followed by adjuvant mitotane treatment
C) MR scan of adrenal glands with chemical shift analysis
D) left adrenalectomy followed by adjuvant combination chemotherapy
E) adrenal fine-needle biopsy

4. 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) 2 years
B) 5 years
C) 1 year
D) immediately
E) 10 years

5. A 16-year-old boy was referred to the endocrine clinic. He was concerned about his growth and pubertal development. He was well with no significant medical history. He had felt his development had lagged behind his peers for the previous 2 years and he had been the shortest in his class for some time and was being bullied.
General examination was normal. His height was 1.53 m and weight 52.4 kg. He had Tanner stage 3 genitalia and pubic hair. Axillary hair was present. Testicular volumes were 6 mL bilaterally.
Investigations:
serum testosterone4.4 nmol/L (9.0-35.0)
plasma follicle-stimulating hormone2.5 U/L (1.0-7.0)
plasma luteinising hormone1.8 U/L (1.0-10.0)
serum insulin-like growth factor 134.5 nmol/L (9.3-56.0)
insulin tolerance test:

What is the most appropriate treatment?

A) reassure and review
B) testosterone 50 mg intramuscularly per month
C) hydrocortisone 15 mg am, 5 mg pm
D) growth hormone 0.4 mg subcutaneously per day
E) testosterone 250 mg intramuscularly per month

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