Category: Endocrinology

MRCP-0425

A 30-year-old woman who works in a pharmacy comes to the clinic for review. Over the past few months, she has lost increasing amounts of weight and has become increasingly anxious about palpitations, which occur mostly at night. Her TSH is <0.1 IU/l (0.5-4.5). On examination, her BP is 122/72 mmHg, her pulse is 92 and regular. You cannot palpate a goitre or any nodules on examination of her neck. Which of the following investigations can differentiate between self-administration of thyroid hormone and endogenous causes of thyrotoxicosis?

MRCP-0413

A 72-year-old man presents with chronic back and right hip pain which has been increasingly affecting him over the past few months. He finds it very difficult to mobilise in the mornings. Clinical examination is unremarkable, apart from a limitation of right hip flexion due to pain. Investigations show: Haemoglobin 12.1 g/dl (13.5-17.7), White cell count 8.2 x 109/l (4-11), Platelets 200 x 109/l (150-400), C reactive protein 9 nmol/l (<10), ESR 15 mm/hr (<20), Sodium 140 mmol/l (135-146), Potassium 3.9 mmol/l (3.5-5), Creatinine 92 µmol/l (79-118), Alanine aminotransferase 12 U/l (5-40), Alkaline phosphatase 724 U/l (39-117), Calcium 2.55 mmol/l (2.20-2.67). Which of the following is the most likely diagnosis?

MRCP-0414

A 25-year-old woman presents to the clinic with nausea, thirst and dehydration. She mentioned that she has an uncle with previous parathyroid gland excision and a cousin who has recently been diagnosed with insulinoma. On examination, her BP is 135/72 mmHg, her pulse is 70/min and regular, her BMI is 20. Cardiovascular, respiratory and abdominal examinations are unremarkable. Investigations show: Hb 12.6 g/dL, WCC 5.4 x109/L, PLT 299 x109/L, Na+ 139 mmol/L, K+ 4.4 mmol/L, Creatinine 121 ىmol/L, Albumin 37 g/l, Ca++ 2.95 mmol/L, PTH 18 (normal<10). Which of the following is the most likely cause of her raised calcium?

MRCP-0415

A 40-year-old man presents with a history of carpal tunnel syndrome and osteoarthritis of his weight-bearing joints. He has recently begun to suffer from symptoms of sleep apnoea. On examination, he has a prominent jawline and macroglossia. His BP is elevated at 155/95 mmHg and there is peripheral visual field loss. Which of the following is true?

MRCP-0416

All of the following are true regarding carcinoid syndrome, except?

MRCP-0417

A 19-year-old woman comes to the endocrine clinic with excessive hairiness and acne. She tells you that she has a period only every few months and when she has one it tends to be very heavy. On examination, she has obvious facial acne. Her BP is 142/78 mmHg, her pulse is 72bpm and regular and her BMI is 30. There is facial hair and hair around her upper chest and breasts. Investigations show: Haemoglobin 11.9 g/dl (11.5-16.0), White cell count 6.0 x 10(9)/l (4-11), Platelets 202 x 10(9)/l (150-400), Sodium 137 mmol/l (135-146), Potassium 3.9 mmol/l (3.5-5), Creatinine 90 µmol/l (79-118), Total testosterone normal, Free androgen index elevated, LH / FSH ratio 2.2. Which of the following is the most likely diagnosis?

MRCP-0418

Which of the following is most consistent with congenital adrenal hyperplasia (CAH)?

MRCP-0419

Which one of the following is the most common cause of hypothyroidism in the UK?

MRCP-0420

A 28-year-old woman is evaluated in the endocrinology clinic for increased urine output. She weighs 60 kg and has a 24-hour urine output of 3500 ml. Her basal urine osmolality is 210 mOsm/kg. She undergoes a fluid deprivation test and her urine osmolality after fluid deprivation (loss of weight 3 kg) is 650 mOsm/kg. Subsequent injection of subcutaneous DDAVP (desmopressin acetate) did not result in a further significant rise of urine osmolality after 2 hours (655 mOsm/kg). Which of the following is the most likely diagnosis?

MRCP-0421

A 77-year-old woman is admitted in an unconscious state. On examination in casualty, her temperature is 33 °C and she was in left ventricular failure. Her blood glucose level is 5.7 mmol/l and random cortisol is elevated. Free T4 is 4.4 pmol/l. A CT scan of her brain reveals no focal lesion and a cursory assessment reveals no gross focal neurology. Which diagnosis fits best with this woman’s clinical picture?