SEND 무료 덤프문제 온라인 액세스
| 시험코드: | SEND |
| 시험이름: | Endocrinology and Diabetes (Specialty Certificate Examination) |
| 인증사: | MRCPUK |
| 무료 덤프 문항수: | 200 |
| 업로드 날짜: | 2026-07-08 |
A 56-year-old man presented with a 6-month history of erectile dysfunction. He had noticed a gradual reduction in his frequency of shaving from daily to twice a week. His libido had diminished and he felt that he was not as strong as he once was. He also described general aches and pains. He was a farm worker and had drunk a bottle of vodka daily for several years, but had stopped drinking 2 years previously. He was a non-smoker.
Investigations:
serum urea6.2 mmol/L (2.5-7.0)
serum creatinine89 umol/L (60-110)
serum albumin40 g/L (37-49)
serum total bilirubin17 umol/L (1-22) serum alanine aminotransferase48 U/L (5-35) serum aspartate aminotransferase37 U/L (1-31) haemoglobin A1c55 mmol/mol (20-42)
serum cortisol (09.00 h)389 nmol/L (200-700) serum testosterone0.7 nmol/L (9.0-35.0) plasma follicle-stimulating hormone2.1 U/L (1.0-7.0) plasma luteinising hormone2.4 U/L (1.0-10.0) serum prolactin458 mU/L (<360) serum thyroid-stimulating hormone3.4 mU/L (0.4-5.0)
MR scan of pituitarysee image
What is the most likely explanation of his symptoms?
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 36-year-old man of South Asian origin presented acutely with a widespread pruritic rash involving the extensor surfaces of the limbs.
On examination, he was moderately obese with a body mass index of 33 kg/m2 (18-25), and the rash was erythematous, with multiple small papules with yellow centres.
Investigations:
fasting plasma glucose11.0 mmol/L (3.0-6.0)
haemoglobin A1c109 mmol/mol (20-42)
serum cholesterol8.0 mmol/L (<5.2)
serum HDL cholesterol0.80 mmol/L (>1.55)
fasting serum triglycerides31.00 mmol/L (0.45-1.69)
What is the most likely diagnosis?
Carbimazole is routinely used in the management of thyroid disease.
What does carbimazole inhibit?
A 17-year-old girl was referred to the transition clinic. She was taking hydrocortisone 10 mg twice daily and fludrocortisone 150 micrograms daily following a failed short tetracosactide (Synacthen@) test 5years previously. She had entered puberty at the age of 10 but had never achieved adult breast development or menarche.
Investigations:
haemoglobin95 g/L (115-165)
MCV124 fL (80-96)
white cell count8.4 ? 109/L (4.0-11.0)
platelet count334 ? 109/L (150-400)
serum sodium138 mmol/L (137-144)
serum potassium4.4 mmol/L (3.5-4.9)
serum urea3.5 mmol/L (2.5-7.0)
serum corrected calcium1.80 mmol/L (2.20-2.60)
serum follicle-stimulating hormone67.9 U/L (2.5-10.0)
serum luteinising hormone56.4 U/L (2.5-10.0)
What is the most likely diagnosis?