MRCPUK Endocrinology and Diabetes (Specialty Certificate Examination) : SEND

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MRCPUK Endocrinology and Diabetes (Specialty Certificate Examination) SEND Prüfungsfragen mit Lösungen:

1. An 18-year-old man was referred with muscle weakness and cramps. His blood pressure was 108/60 mmHg.
Investigations:
serum sodium143 mmol/L (137-144) serum potassium2.4 mmol/L (3.5-4.9) serum bicarbonate32 mmol/L (20-28) serum magnesium0.96 mmol/L (0.75-1.05)
24-h urinary calcium3.6 mmol (2.5-7.5) 24-h urinary magnesium4.2 mmol (2.5-8.0)
plasma renin activity (after 30 min supine)6.4 pmol/mL/h (1.1-2.7) plasma aldosterone (after 30 min supine)680 pmol/L (135-400)
What is the most likely diagnosis?

A) Bartter's syndrome
B) Gitelman's syndrome
C) renal tubular acidosis
D) syndrome of apparent mineralocorticoid excess
E) Liddle's syndrome

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

3. A 37-year-old man, who had previously undergone female-to-male gender reassignment surgery, attended the endocrine clinic for annual review. He had no complaints and was happy with the results of his treatment. His medication consisted of testosterone undecanoate 1 g intramuscularly every 3 months.
What variable is it most important to monitor?

A) haematocrit
B) serum testosterone
C) fasting plasma glucose
D) serum prostate-specific antigen
E) serum luteinising hormone

4. A 42-year-old policewoman presented with thirst, polyuria and tiredness of 3 months' duration. She gave a family history of thyrotoxicosis.
On examination, her pulse was 108 beats per minute and her blood pressure was 150/70 mmHg. She had a fine tremor and diffuse thyroid enlargement. She also had mild proptosis.
Investigations:
haemoglobin146 g/L (115-165)
platelet count164 ? 109/L (150-400)
serum sodium143 mmol/L (137-144)
serum creatinine135 umol/L (60-110)
serum corrected calcium3.60 mmol/L (2.20-2.60)
serum thyroid-stimulating hormone<0.02 mU/L (0.4-5.0)
serum free T431.9 pmol/L (10.0-22.0)
serum free T315.6 pmol/L (3.0-7.0)
What is the most appropriate next investigation?

A) plasma parathyroid hormone
B) isotope bone scan
C) fine-needle aspiration of thyroid
D) serum phosphate
E) 24-h urinary calcium

5. A 33-year-old woman was reviewed in the insulin pump clinic. She had had type 1 diabetes mellitus for 10 years. She had been treated with a continuous subcutaneous insulin infusion 3 years previously, because of frequent hypoglycaemic episodes. She had recently undergone continuous glucose monitoring (see image).

Investigations:
haemoglobin A1c43 mmol/mol (20-42)
What is the most likely cause of the blood glucose trace seen between 08.00 h and 10.00 h?

A) overcorrection of hypoglycaemia
B) dawn phenomenon
C) inadequate mealtime insulin bolus
D) blocked infusion set
E) inadequate basal insulin rate

Fragen und Antworten: