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Endocrinology and Diabetes (Specialty Certificate Examination) 試験
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Question No : 1
A 25-year-old woman presented at 28 weeks’ gestation after a screening 75-g oral glucose tolerance test, which had shown a fasting plasma glucose of 5.6 mmol/L (3.0C6.0) and a 2-h plasma glucose of 9.8 mmol/L (<7.8). She had a family history of type 2 diabetes mellitus and a pre-pregnancy body mass index of 36 kg/m2 (18C25). Home blood glucose monitoring had shown persistently raised blood glucose despite dietary modification. She refused insulin because of needle phobia and was concerned about drug exposure to her unborn child.
The use of what hypoglycaemic therapy is acceptable in this situation?
正解:
Question No : 2
A 67-year-old woman with type 2 diabetes mellitus presented to the foot clinic with an ulcer at the plantar aspect of her fifth left toe. The ulcer probed to bone but there were no signs of inflammation. There had been a little improvement during 6 weeks of podiatric treatment, but there was some concern about possible osteomyelitis. An X-ray of toe 4 weeks
previously had been normal.
What is the most appropriate next investigation?
正解:
Question No : 3
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 (18C25). 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 (200C700)
serum oestradiol51 pmol/L (200C400)
serum follicle-stimulating hormone0.8 U/L (2.5C10.0)
serum luteinising hormone1.2 U/L (2.5C10.0)
serum thyroid-stimulating hormone1.2 mU/L (0.4C5.0)
serum free T415.6 pmol/L (10.0C22.0)
What is the most appropriate next investigation?
正解:
Question No : 4
A 55-year-old male-to-female transsexual was reviewed in clinic. She lived as a woman but had not undergone gender reassignment surgery. She was treated with cyproterone acetate 50 mg twice daily and estradiol 2 mg twice daily.
What are the most important tests for monitoring safe replacement?
正解:
Question No : 5
A 24-year-old man was referred for investigation of infertility. He had been having unprotected intercourse with his partner for 18 months, but the couple had failed to conceive. He had been treated for Hodgkin’s lymphoma at the age of 17.
What is the most appropriate investigation?
正解:
Question No : 6
A 46-year-old Afro-Caribbean man with sarcoidosis was found to have hypercalcaemia and was treated with prednisolone 20 mg/day. Within 3 weeks his serum calcium had fallen to within the reference range.
How do glucocorticoids reduce serum calcium in sarcoidosis?
正解:
Question No : 7
A 17-year-old boy with a 10-year history of type 1 diabetes mellitus was admitted with
diabetic ketoacidosis after a night of binge drinking.
He was treated appropriately with a fixed-rate intravenous insulin infusion and intravenous sodium chloride 0.9%.
Twenty-four hours after admission, he was eating and drinking normally. He was taking his usual doses of subcutaneous insulin and his urinary ketones were undetectable.
Investigations (6 hours previously):
venous blood gases, breathing air:
PO25.6 kPa
PCO23.8 kPa
pH7.29
bicarbonate16 mmol/L
base excessC1 mmol/L
lactate1.1 mmol/L
What is the likely most cause of these results?
正解:
Question No : 8
An 80-year-old man was referred because of weight gain and low mood but said he was otherwise well. He had a complex cardiac history including a ventricular fibrillation arrest and a permanent pacemaker, but he had been very well for the past 3 years. He was taking amiodarone 100 mg daily, lisinopril 40 mg daily and furosemide 80 mg daily.
On examination, he had a pacemaker in situ and his pulse was 84 beats per minute and regular. He had a 2/6 mid-systolic murmur in the aortic area with no radiation, mild ankle oedema, and scanty basal crackles bilaterally on auscultation of his chest.
Investigations (before attending clinic):
serum thyroid-stimulating hormone19.0 mU/L (0.4C5.0)
serum free T411.0 pmol/L (10.0C22.0)
anti-thyroid peroxidase antibodies300 IU/mL (<50)
What is the most appropriate next step in management?
正解:
Question No : 9
A 32-year-old man presented to the emergency department after becoming acutely unwell.
He had a 5-year history of type 1 diabetes mellitus and no other significant medical history.
On examination, he was apyrexial, his pulse was 120 beats per minute, his blood pressure was 96/58 mmHg and his respiratory rate was 32 breaths per minute.
Investigations:
random plasma glucose14.2 mmol/L
arterial blood gases, breathing 60% oxygen:
PO28.9 kPa (11.3C12.6)
PCO22.6 kPa (4.7C6.0)
pH7.10 (7.35C7.45)
H+79 nmol/L (35C45)
bicarbonate6.1 mmol/L (21C29)
base excessC18 mmol/L (±2)
What diagnosis is most likely to account for these results?
正解:
Question No : 10
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 (9.0C35.0)
serum follicle-stimulating hormone1.0 U/L (1.0C7.0)
serum luteinising hormone1.5 U/L (1.0C10.0)
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?
正解:
Question No : 11
A 26-year-old woman was referred by her general practitioner for the management of subfertility. Her menarche had occurred at the age of 14 and she had experienced oligomenorrhoea since the age of 16. She also complained of gradually worsening hirsutism since puberty.
Clinical examination showed central obesity, a body mass index of 32 kg/m2 (18C25) and a blood pressure of 140/90 mmHg.
The following results were obtained within 1 week of her last menstrual period.
Investigations:
overnight dexamethasone suppression test (after 1 mg dexamethasone):
serum cortisol30 nmol/L (<50)
serum dehydroepiandrosterone sulphate12 µmol/L (3C12)
serum androstenedione10.0 nmol/L (0.6C8.8)
serum 17-hydroxyprogesterone38 nmol/L (1C10)
serum oestradiol200 pmol/L (200C400)
serum testosterone3.5 nmol/L (0.5C3.0)
serum sex hormone binding globulin30 nmol/L (40C137)
plasma follicle-stimulating hormone4.0 U/L (2.5C10.0)
plasma luteinising hormone6.0 U/L (2.5C10.0)
What is the most likely diagnosis?
正解:
Question No : 12
A 55-year-old woman presented complaining of difficulty losing weight.
On examination, her blood pressure was 170/105 mmHg and urinalysis showed protein 1+.
An ultrasound scan of abdomen revealed a 4.5-cm solid lesion in the right adrenal gland.
She was treated with ramipril and further endocrine evaluation was performed.
Investigations:
serum potassium3.6 mmol/L (3.5C4.9)
serum creatinine135 µmol/L (60C110)
plasma renin activity:
(after 30 min supine)3.9 pmol/mL/h (1.1C2.7)
(after 30 min upright)6.8 pmol/mL/h (3.0C4.3)
plasma aldosterone:
(after 30 min supine)150 pmol/L (135C400)
(after 4 h upright)350 pmol/L (330C830)
serum cortisol (09.00 h)650 nmol/L (200C700)
serum cortisol (22.00 h)225 nmol/L (50C250)
24-h urinary free cortisol230 nmol (55C250)
24-h urinary dopamine3200 nmol (<3100)
24-h urinary adrenaline120 nmol (<144)
24-h urinary noradrenaline450 nmol (<570)
What is the most appropriate initial management of the adrenal lesion?
正解:
Question No : 13
A 35-year-old woman was referred with a left lower thyroid lesion. She was asymptomatic.
Examination confirmed the presence of a 2 ? 3-cm, firm, mobile, non-tender mass.
Investigations:
ultrasound-guided fine-needle aspiration biopsyThy 5
How is Thy 5 defined?
正解:
Question No : 14
A 46-year-old South Asian man presented with a 2-month history of dry mouth and polyuria. He had hypertension treated with bendroflumethiazide. There was no family history of diabetes mellitus, but his father had died suddenly during lower limb angioplasty at the age of 51.
On examination, the patient’s pulse was 76 beats per minute and regular, and his blood pressure was 164/86 mmHg. The rest of the physical examination was normal. Urinalysis was normal.
Investigations:
serum sodium143 mmol/L (137C144)
serum potassium3.0 mmol/L (3.5C4.9)
serum creatinine123 µmol/L (60C110)
fasting plasma glucose6.9 mmol/L (3.0C6.0)
What is the most appropriate next step in management?
正解:
Question No : 15
A 19-year-old man was seen in the diabetes clinic. He had lost 2 kg in weight since the diagnosis of diabetes mellitus 18 months previously. At presentation, his body mass index was 33 kg/m2 (18C25), his random plasma glucose was 18.0 mmol/L and his haemoglobin A1c was 56 mmol/mol (20C42). He was taking gliclazide, and metformin had been added later. His father and grandfather had developed diabetes mellitus during their twenties.
Investigations:
haemoglobin A1c56 mmol/mol (20C42)
serum C-peptide301 pmol/L (180C360)
anti-glutamic acid decarboxylase (GAD)
antibodiesnegative
What is the most likely diagnosis?
正解: