Category: Endocrinology

MRCP-0366

A 50-year-old woman is referred to the outpatient clinic with a 6-month history of diarrhoea. She has had intermittent loose normal-coloured stools 2-3 times a day. She also has up to 10 hot flushes a day but thinks she is entering menopause; her GP has recently started her on hormone replacement therapy. 15 years ago she had a normal colonoscopy after presenting with abdominal pain and intermittent constipation. She has asthma controlled by inhalers, hypertension controlled by ACE inhibitors and hypothyroidism controlled by thyroxine. She smoked 10 cigarettes a day for the last 30 years and drinks alcohol about 14 units/week. On examination, she looks hot and flushed. She is afebrile. Her pulse is regular 92bpm and her BP is 164/82 mmHg. Her respirator rate is 20 breaths/min at rest and she sounds quite wheezy. A widespread polyphonic expiratory wheeze can be heard on chest auscultation. Her abdomen is soft. Her liver is enlarged 4 cm below the right costal margin but not-tender. Results of blood tests show: Na 140 mmol/L, K 4.8 mmol/L, Glucose 9.8 mmol/L, Albumin 41 g/l, ALT 94 U/l, ALP 61 U/l, Bilirubin 18 mmol/L, Ca 2.47 mmol/L, WCC 10.1 × 109/L, Hb 12.2 g/dL, MCV 90.5 fl, Platelets 234 × 109 /l, PT 13 s. Chest X-ray is normal. Ultrasound of the liver shows an enlarged liver containing three ill-defined mass lesions in the right lobe. What is the most likely diagnosis?

MRCP-0367

A 60-year-old man with type 1 diabetes is brought to the clinic with his wife. He is limping and his wife noticed that his ankle was abnormally-shaped after he stepped out of the shower. Examination of his right ankle reveals a painless warm swollen joint. There is crepitus and what appears to be palpable bone debris. X-ray reveals gross joint destruction and apparent dislocation. Joint aspiration fluid shows no microbes. Investigations: His CRP and white count are of normal values. Historical review of HB A1c reveals that it has rarely been below 9%. What is the most likely diagnosis?

MRCP-0368

A 23-year-old woman presents with hirsutism and oligomenorrhea for the last five years. She is very anxious about her irregular menses and worried as her mother was diagnosed with uterine cancer recently. She is a lawyer and does not want to conceive, at least for the next couple of years. The examination is essentially normal except for coarse dark hair being noticed under her chin and over her lower back. Investigations done during the follicular phase: Serum androstenedione 10.1 nmol/l (0.6-8.8), Serum dehydroepiandrosterone sulphate 11.6 ىmol/l (2-10), Serum 17-hydroxyprogesterone 5.6 nmol/l (1-10), Serum oestradiol 220 pmol/l (200-400), Serum testosterone 3.6 nmol/l (0.5-3), Serum sex hormone binding protein 32 nmol/l (40-137), Plasma luteinising hormone 3.3 U/l (2.5-10), Plasma follicle-stimulating hormone 3.6 U/l (2.5-10). What is the most appropriate treatment?

MRCP-0369

A 16-year-old girl comes to clinic complaining of primary amenorrhoea, despite having developed secondary sexual characteristics at 11 years of age. On examination, she has well-developed breasts and small bilateral groin swellings. What is the most likely diagnosis?

MRCP-0370

Regarding the pathophysiology of diabetes mellitus, which of the following is true?

MRCP-0371

A 45-year-old man with diabetes comes to the clinic for his annual review. He has had diabetes for eight years and he is also being treated for hypertension. He is on the following medications: metformin 500 mg tds, gliclazide 80 mg daily, atorvastatin 10 mg/d, Ramipril 10 mg/d and Bendroflumethiazide 2.5 mg/d. He is noted to be obese (130kg). Physical examination is otherwise unremarkable. Investigations reveal: HbA1c 8.1% (3.8-6.4), Fasting glucose 9 mmol/L (3.0-6.0), 24hr Urine free cortisol 354 mmol/d (<250), 9am Plasma ACTH 4 ng/dL (10-50). CT abdomen 3cm right adrenal mass. Which of the following is most likely to be the adrenal mass?

MRCP-0372

A 43-year-old woman is concerned about osteoporosis as she as a strong family history of it. She is one year postmenopausal and aware of hot flushes at night. Which one of the following therapies would be most appropriate?

MRCP-0373

A 40-year-old woman presents to the ED with palpitations and shortness of breath. Recent thyroid function tests on the hospital computer reveal thyroid-stimulating hormone (TSH) of <0.05 mU/l and a markedly elevated T4. You arrange blood gas testing. Which of the following findings would be most consistent with Grave’s disease?

MRCP-0358

A 65-year-old woman presents at clinic complaining of worsening hoarseness of voice and dyspnoea over the past month. She has a history of toxic multinodular goitre successfully treated with radioiodine. On examination, she has a firm asymmetrical swelling of the thyroid gland. Laryngoscopy demonstrates a right vocal cord paralysis and apparent external compression of the trachea. What is the most likely diagnosis?

MRCP-0359

In a patient with Hashimoto’s thyroiditis, which of the following is most specific to the disease?