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MRCPUK SEND 시험 개요:

MRCPUK SEND 시험 요강 주제:

MRCPUK SEND 시험 궁금증 해소 코너

최신 MRCPUK Certification SEND 무료샘플문제

문제 #1

A 48-year-old man was referred by his general practitioner, whose letter stated: 'Please review this man's blood pressure management, as he has requested a second opinion, having seen information on the internet about the need for more detailed investigation. He has been having treatment for 10 years.'
At the consultation, the patient confirmed that he was currently taking bendroflumethiazide
2.5 mg daily, atenolol 50 mg daily and perindopril 8 mg daily. His clinic blood pressure was 169/108 mmHg. Clinical examination was otherwise normal.
Investigations:
serum sodium142 mmol/L (137-144)
serum potassium3.9 mmol/L (3.5-4.9)
estimated glomerular filtration rate (MDRD)>60 mL/min/1.73 m2 (>60)
ambulant plasma renin activity0.5 pmol/mL/h (3.0-4.3)
ambulant plasma aldosterone380 pmol/L (330-830)
What is the most appropriate next step in management?

A. CT scan of adrenal glands
B. withdraw atenolol and repeat renin and aldosterone
C. add amlodipine
D. urine steroid profile
E. fludrocortisone suppression test

문제 #2

A 54-year-old man was referred to the diabetes foot clinic with a plantar foot ulcer of 3 months' duration under the right first metatarsal head. He had a 10-year history of type 2 diabetes mellitus. He lived alone and had to do his own shopping and cleaning.
On examination, the ulcer was 3 ? 2 cm in area, 4 mm in depth, and had a clean granulating base. He had strong palpable pedal pulses and sensory neuropathy in both feet.
What is the most effective intervention to heal this ulcer?

A. long-term oral antibiotics
B. Manuka honey-impregnated wound dressing
C. total contact casting
D. removable pressure-relieving boot
E. ambulatory vacuum-assisted pump therapy

문제 #3

A 72-year-old man with a dense residual hemiparesis and unsafe swallow was fed via a percutaneous gastrostomy for 20 hours each day. He resided in a nursing home and had type 2 diabetes mellitus that had been well controlled on metformin.
His glucose concentrations were uncontrolled on metformin powder at maximum dose. While not being fed, his blood glucose was measured.
Investigations:
capillary blood glucose3.1 mmol/L
According to the Joint British Diabetes Societies Guidelines (2012), what is the most appropriate management?

A. Glucogel@ ? 2 down gastrostomy tube
B. Glucogel@ ? 2 given buccally
C. glucose 20% 150 mL intravenously
D. restart feed to deliver carbohydrate 20 g rapidly
E. Fortisip@ 110 mL

문제 #4

A 46-year-old man of European descent was reviewed in the diabetes clinic. He had type 2 diabetes mellitus, which had been diagnosed 6 months previously. He had been symptom free and was a non-smoker but had a family history of cardiovascular disease. He exercised regularly and had managed to lose 8 kg.
On examination, his blood pressure was 148/76 mmHg, his weight was 76 kg and his body mass index was 24 kg/m2 (18-25).
Investigations:
urinary albumin:creatinine ratio0.6 mg/mmol (<2.5)
serum cholesterol5.6 mmol/L (<5.2)
serum HDL cholesterol0.90 mmol/L (>1.55)
fasting serum triglycerides2.20 mmol/L (0.45-1.69)
According to NICE guidelines (CG181, July 2014), what is the most appropriate management of his lipid profile?

A. start nicotinic acid
B. start a fibrate
C. observe and repeat lipid profile in a few months
D. assess cardiovascular risk using UKPDS risk engine
E. start a statin

문제 #5

A 64-year-old man was reviewed in the diabetes clinic. He had a history of type 2 diabetes mellitus treated for 12 years. He had sustained a previous episode of acute kidney injury believed to be secondary to renal artery stenosis and exposure to an ACE inhibitor. He was being treated with metformin 500 mg three times daily and gliclazide 80 mg twice daily.
Investigations:
serum sodium143 mmol/L (137-144)
serum potassium4.4 mmol/L (3.5-4.9)
serum creatinine123 umol/L (60-110)
estimated glomerular filtration rate (MDRD)51 mL/min/1.73 m2 (>60)
haemoglobin A1c75 mmol/mol (20-42)
He required a third drug that would not require dose adjustment if renal function were to decline in the future.
What additional medication is most appropriate?

A. sitagliptin
B. linagliptin
C. saxagliptin
D. vildagliptin
E. alogliptin

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