최신 MRCPUK Certification SEND 무료샘플문제:

1. A 25-year-old woman presented with a solitary nodule in the right lobe of her thyroid gland.
Investigations:
serum thyroid-stimulating hormone0.45 mU/L (0.4-5.0)
serum free T420.7 pmol/L (10.0-22.0)
The presence of which feature would most increase the likelihood of malignancy?

A) microcalcification seen within the nodule on ultrasound scan
B) high titre of thyroid peroxidase antibodies
C) size of nodule >1.0 cm in maximum diameter
D) elevated serum thyroglobulin concentration
E) increased peripheral vascularity of nodule on Doppler ultrasound

2. 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?

A) lipid profile and serum prostate-specific antigen
B) liver function tests and full blood count
C) liver function tests and serum prostate-specific antigen
D) lipid profile and liver function tests
E) serum prostate-specific antigen and full blood count

3. A pregnant 36-year-old woman presented to the diabetes outpatient clinic. She had type 2
diabetes mellitus treated with diet, lifestyle changes and metformin 500 mg twice daily.
On examination, her blood pressure was 128/84 mmHg.
Investigations:
haemoglobin A1c47 mmol/mol (20-42)
urinary albumin:creatinine ratio1.6 mg/mmol (<3.5)
Which is the best agent to reduce the risk of pre-eclampsia in this patient?

A) labetalol
B) insulin
C) omega-3-marine triglycerides
D) folic acid
E) aspirin

4. A 62-year-old woman was referred with generalised weakness. She had no previous history of note and was not taking any medication. She reported drinking 60 units of alcohol per week.
On examination, she was found to have central adiposity, pale abdominal striae and
wasting of the limb muscles. Her blood pressure was raised at 160/100 mmHg.
Investigations:
serum sodium138 mmol/L (137-144)
serum potassium3.8 mmol/L (3.5-4.9)
serum cortisol (09.00 h)750 nmol/L (200-700)
low-dose dexamethasone suppression test (2 mg/day for 48 h):
serum cortisol120 nmol/L (<50)
high-dose dexamethasone suppression test (8 mg/day for 48 h):
serum cortisol45 nmol/L (should suppress to
<50% of day 0 value)
24-h urinary free cortisol 360 nmol (55-250)
plasma adrenocorticotropic hormone (09.00 h)22.0 pmol/L (3.3-15.4)
MR scan of pituitary glandnormal
CT scan of adrenal glands1-cm mass in the left adrenal gland
What is the most likely cause for her presentation?

A) Cushing's disease
B) pseudo-Cushing's syndrome
C) adrenal adenoma
D) ectopic adrenocorticotropic hormone syndrome
E) adrenal carcinoma

5. 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 (137-144)
serum potassium3.0 mmol/L (3.5-4.9)
serum creatinine123 umol/L (60-110)
fasting plasma glucose6.9 mmol/L (3.0-6.0)
What is the most appropriate next step in management?

A) haemoglobin A1c measurement
B) change bendroflumethiazide to ramipril
C) oral glucose tolerance test
D) start oral hypoglycaemic treatment
E) repeat fasting plasma glucose

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