SEND 試験問題を無料オンラインアクセス
| 試験コード: | SEND |
| 試験名称: | Endocrinology and Diabetes (Specialty Certificate Examination) |
| 認定資格: | MRCPUK |
| 無料問題数: | 200 |
| 更新日: | 2025-08-25 |
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 17-year-old girl was referred to the outpatient clinic with irritability, weight loss and difficulty sleeping. At the age of 4, she had presented with rapid growth, breast development and vaginal bleeding. The results of a gonadotropin-releasing hormone (GnRH) stimulation test performed at that time are given below.
serum oestradiolplasma FSHplasma LH
(200-400 pmol/L)(2.5-10.0 U/L)(2.5-10.0 U/L)
0 min365<0.7<0.5
30 min-<0.7<0.5
60 min-<0.7<0.5
She had been treated with GnRH analogue until the age of 11 and puberty had then progressed normally.
On examination, she was found to be tremulous, tachycardic and hyper-reflexic. Several large, irregular cafe-au-lait spots were found.
Investigations:
serum thyroid-stimulating hormone<0.05 mU/L (0.4-5.0)
serum free T436.0 pmol/L (10.0-22.0)
What is the most likely diagnosis?
A 34-year-old woman with a 21-year history of type 1 diabetes mellitus had started treatment with subcutaneous insulin pump therapy 18 months previously. Her haemoglobin A1c before starting pump therapy was 77 mmol/mol (20-42) and she had experienced severe hypoglycaemic events without warning symptoms over the previous 4 years.
At review in clinic, she reported continuing episodes of severe hypoglycaemia without warning symptoms despite regular monitoring and advice from her insulin pump nurse specialist.
On examination, her blood pressure was 134/80 mmHg and fundoscopy revealed moderate background diabetic retinopathy. Examination of the feet revealed strong, palpable pedal pulses and early evidence of sensory neuropathy.
Investigations:
estimated glomerular filtration rate (MDRD)24 mL/min/1.73 m2 (>60)
haemoglobin A1c56 mmol/mol (20-42)
24-h urinary total protein2.3 g (<0.2)
What is the most appropriate next step in management?
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 29-year-old woman presented with primary infertility, having had unprotected sexual intercourse for 15 months. Menarche had occurred at the age of 13.5 years. Her menstrual cycle was irregular, occurring every 20-60 days. There was no history of galactorrhoea. She denied abnormal hair growth.
On examination, her body mass index was 28.9 kg/m2 (18-25) and she had normal secondary sexual characteristics. Her visual fields were full to confrontation.
Investigations:
serum androstenedione12.8 nmol/L (0.6-8.8)
serum oestradiol205 pmol/L (200-400)
serum testosterone2.4 nmol/L (0.5-3.0)
serum sex hormone binding globulin23 nmol/L (40-137)
serum follicle-stimulating hormone4.3 U/L (2.5-10.0)
serum luteinising hormone8.5 U/L (2.5-10.0)
serum prolactin420 mU/L (<360)
hysterosalpingogrampatent fallopian tubes
partner's semen analysisnormal sperm count and motility
What is the most appropriate first-line intervention?