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最新的 MRCPUK Certification SEND 免費考試真題:

1. A 26-year-old woman presented acutely with abdominal pain. On examination, her blood pressure was 124/72 mmHg.
Investigations:
24-h urinary dopamine10 000 nmol (<3100)
24-h urinary adrenaline43 nmol (<144)
24-h urinary noradrenaline146 nmol (<570)
CT scan of abdomen3-cm left para-aortic mass
She underwent surgical exploration and removal of the lesion, which proved to be a paraganglioma. One local lymph node, removed at the same time, was also positive for the presence of tumour.
What is the most likely underlying genetic syndrome?

A) von Hippel-Lindau syndrome
B) multiple endocrine neoplasia type 2a
C) neurofibromatosis type 1 mutation
D) succinate dehydrogenase type B mutation
E) Gardner's syndrome

2. A 50-year-old Asian woman with an 18-year history of type 2 diabetes mellitus complained of discomfort and mild swelling in her left foot after tripping on a pavement. She was being treated with metformin, gliclazide and pioglitazone.
On examination, her foot was warm and slightly oedematous over the dorsum but not discoloured. She was afebrile and the foot pulses were bounding. Tendon reflexes in the legs were absent and vibration perception diminished. Urinalysis showed protein 2+, glucose 1+.
Investigations:
white cell count5.2 ? 109/L (4.0-11.0)
serum creatinine140 umol/L (60-110)
haemoglobin A1c63 mmol/mol (20-42)
X-ray of left footnormal bone architecture; some calcification of the arteries
isotope bone scanincreased isotope uptake in the mid-foot only
What is the most effective next step in management?

A) below-knee removable walking boot
B) alendronic acid
C) immobilisation in a cast
D) co-amoxiclav
E) celecoxib

3. Five patients were referred to a rapid access thyroid clinic. Only four slots were available in the following month.
Which patient can safely be deferred to a later clinic?

A) 44-year-old woman with a history of sudden-onset pain in a thyroid lump
B) 67-year-old man with a goitre and hoarseness
C) 16-year-old boy with a thyroid nodule
D) 45-year-old woman with a rapidly enlarging painless goitre
E) 39-year-old woman with a slowly growing thyroid lump and a palpable cervical lymph node

4. 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

5. A 75-year-old woman presented with a 4-week history of lethargy. Her medical history was unremarkable and she took no medication.
On examination, her blood pressure was 140/70 mmHg lying. She was euvolaemic.
Investigations:
serum sodium120 mmol/L (137-144)
serum potassium3.8 mmol/L (3.5-4.9)
serum urea3.0 mmol/L (2.5-7.0)
serum creatinine75 umol/L (60-110)
short tetracosactide (Synacthen@) test (250 micrograms):
baseline serum cortisol450 nmol/L (200-700)
serum cortisol (30 min after tetracosactide)600 nmol/L (>550)
serum thyroid-stimulating hormone2.5 mU/L (0.4-5.0)
serum free T416.9 pmol/L (10.0-22.0)
urinary sodium70 mmol/L
What is the most appropriate initial management?

A) intravenous sodium chloride 0.9%
B) demeclocycline
C) tolvaptan
D) hydrocortisone
E) fluid restriction

問題與答案：