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最新的 MRCPUK Certification SEND 免費考試真題:

1. A 16-year-old boy was referred to the endocrine clinic with symptoms of delayed puberty.
On examination, he had a reduced sense of smell, small-sized testes and underdeveloped
secondary sexual characteristics.
Investigations:
serum testosterone3.5 nmol/L (9.0-35.0)
serum follicle-stimulating hormone1.0 U/L (1.0-7.0)
serum luteinising hormone1.5 U/L (1.0-10.0)
serum prolactin220 mU/L (<360)
MR scan of brainnormal
He asked about his future fertility.
What will be the most useful agent for him to achieve fertility?

A) clomifene
B) testosterone
C) bromocriptine
D) gonadotropin-releasing hormones
E) octreotide

2. A 33-year-old woman was seen for diabetes review 2 months after her first pregnancy. Diabetes mellitus had been diagnosed at 18 weeks' gestation. She had experienced no symptoms; routine urinalysis had shown glucose 4+, with no ketones, and her fasting blood glucose concentration was 6.2 mmol/L (3.0-6.0), rising to 13.5 mmol/L (<7.8) in a 75-g oral glucose tolerance test. She had been treated with insulin during the pregnancy, and stopped after delivery. Her mother and maternal aunt had been treated for type 2 diabetes mellitus, and a maternal uncle for type 1 diabetes. Her body mass index was 23.7 kg/m2 (18-25).
Without insulin she remained well, with no osmotic symptoms, no weight loss and no ketosis.
Investigations:
fasting plasma glucose8.4 mmol/L (3.0-6.0)
haemoglobin A1c68 mmol/mol (20-42)
oral glucose tolerance test (75 g):
fasting plasma glucose7.9 mmol/L (3.0-6.0)
2-h plasma glucose13.8 mmol/L (<7.8)
serum insulin72 pmol/L (<186)
serum C-peptide945 pmol/L (180-360)
A trial of therapy with gliclazide 40 mg once daily led to a significant improvement in her blood glucose.
What is the most likely cause of her diabetes?

A) type 1 diabetes mellitus
B) latent autoimmune diabetes in adulthood
C) maturity-onset diabetes of the young caused by HNF-1? mutation
D) type 2 diabetes mellitus
E) maturity-onset diabetes of the young caused by glucokinase mutation

3. A 45-year-old man had type 2 diabetes mellitus of 2 years' duration. He had no history of ischaemic heart disease or microvascular complications, and was euthyroid. There was no family history of ischaemic heart disease. He was a non-smoker and drank 4 to 8 units of alcohol per week. He was taking metformin only.
On examination, his blood pressure was 120/78 mmHg and his body mass index was 24 kg/m2 (18-25).
His calculated 10-year cardiovascular risk was 8.5%.
Investigations (fasting):
serum sodium142 mmol/L (137-144)
serum potassium3.8 mmol/L (3.5-4.9)
serum creatinine90 umol/L (60-110)
haemoglobin A1c48 mmol/L (20-42)
urinary albumin:creatinine ratio1.5 mg/mmol (<2.5)
serum cholesterol5.1 mmol/L (<5.2)
serum HDL cholesterol1.50 mmol/L (>1.55)
fasting serum triglycerides1.22 mmol/L (0.45-1.69)
What does the NICE guidance (CG181, July 2014) on type 2 diabetes mellitus recommend as the most appropriate next step in management?

A) micronised fenofibrate
B) omega-3 marine triglycerides
C) atorvastatin
D) simvastatin
E) no change

4. A 17-year-old girl presented with primary amenorrhoea. She had grown and developed normally. There was no history of galactorrhoea or hirsutism.
On examination, her height was 1.69 m, her weight was 68.3 kg, and her body mass index was 23.9 kg/m2 (18-25). She had stage 5 breast development and stage 5 pubic hair. Her visual fields were full to confrontation.
Investigations:
serum cortisol (09.00 h)416 nmol/L (200-700) serum oestradiol51 pmol/L (200-400)
serum follicle-stimulating hormone0.8 U/L (2.5-10.0) serum luteinising hormone1.2 U/L (2.5-10.0) serum thyroid-stimulating hormone1.2 mU/L (0.4-5.0) serum free T415.6 pmol/L (10.0-22.0)
What is the most appropriate next investigation?

A) serum prolactin
B) serum insulin-like growth factor 1
C) luteinising hormone-releasing hormone test
D) short tetracosactide (Synacthen@) test
E) karyotyping

5. A 35-year-old man presented with newly diagnosed type 2 diabetes mellitus. He had no medical history of note.
When should he inform the UK Driver and Vehicle Licensing Agency (DVLA) of his medical condition?

A) if he starts taking an oral hypoglycaemic agent
B) if he requires laser treatment to one eye
C) if he starts using basal night-time insulin
D) immediately
E) if he becomes unable to read a car number plate with one eye at 20.5 m

問題與答案：