최신 MRCPUK Certification SEND 무료샘플문제:

1. A 43-year-old man presented with a 2-year history of tiredness and reduced libido. He had not been found to have diabetes mellitus.
On examination, his body mass index was 22.4 kg/m2 (18-25), he was poorly virilised and had 10 mL testes.
Investigations:
serum cortisol (09.00 h)220 nmol/L (200-700) serum testosterone4 nmol/L (9.0-35.0) plasma follicle-stimulating hormone1.2 U/L (1.0-7.0) plasma luteinising hormone1.2 U/L (1.0-10.0) serum prolactin150 mU/L (<360) serum thyroid-stimulating hormone1.2 mU/L (0.4-5.0) serum free T48.2 pmol/L (10.0-22.0)
serum insulin-like growth factor 17.8 nmol/L (5.6-23.3)
MR scan of pituitaryempty sella; no mass lesion
An insulin tolerance test was advised to assess both cortisol and growth hormone reserve.
What is the most appropriate dose of insulin (in units/kg body weight) to administer?

A) 0.1
B) 0.01
C) 1.0
D) 0.05
E) 0.5

2. A 17-year-old boy with a 7-year history of type 1 diabetes mellitus was transferred to the adolescent diabetes clinic. He had a history of poor clinic attendance. He admitted to having lost weight recently. His eyes had been photographed by a community ophthalmologist 1 week previously. A photograph of the right fundus is shown (see image).

Investigations:
haemoglobin A1c104 mmol/mol (20-42)
What is the most likely explanation for the retinal appearance?

A) retinitis pigmentosa
B) benign choroidal naevus
C) macular oedema
D) drusen
E) preproliferative diabetic retinopathy

3. 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) TSHoma
B) non-thyroidal illness (sick euthyroid syndrome)
C) thyroid hormone resistance
D) surreptitious ingestion of thyroxine
E) lithium-induced hyperthyroidism

4. A 33-year-old woman presented with tiredness, palpitations, weight loss and emotional
lability 9 weeks after the birth of her third child.
On examination, she had a sinus tachycardia, a fine tremor, slight lid retraction and a mild
diffuse non-tender goitre.
Investigations:
serum thyroid-stimulating hormone<0.01 mU/L (0.4-5.0)
serum free T434.3 pmol/L (10.0-22.0)
technetium-99m scan of thyroid (20-min uptake)<1% (0.4-3.0)
What is the most appropriate treatment?

A) aqueous iodine oral solution
B) potassium perchlorate
C) propranolol
D) carbimazole
E) propylthiouracil

5. An 18-year-old man presented to the thyroid clinic complaining of a lump in his neck that had been present for 9 weeks. It was not painful. At the age of 12, he had developed acute lymphoblastic leukaemia and had undergone a bone marrow transplant preceded by total body irradiation and cyclophosphamide.
On examination, he was euthyroid. There was a 1.5-cm firm mass on the left side of the neck, which moved when he swallowed.
Investigations:
serum thyroid-stimulating hormone1.9 mU/L (0.4-5.0)
serum free T416.8 pmol/L (10.0-22.0)
What is the most appropriate initial course of action?

A) ultrasound-guided fine-needle aspiration of the nodule
B) surgical referral for hemithyroidectomy
C) technetium-99m scintigraphy scan of thyroid
D) CT scan of neck and thorax
E) FDG-PET-CT scan

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