MRCP Part 2 Category: Endocrinology, Diabetes And Metabolic Medicine

MRCP2-1587

A 16-year-old male patient visits the endocrine clinic for evaluation. He reports experiencing excessive urination multiple times a day for as long as he can remember. His GP prescribed him indomethacin to reduce his urine output, but it has not been effective. The patient’s older sister also suffers from a similar condition, but only during pregnancy. During the examination, his blood pressure is 122/82 mmHg, with a postural drop of 15 mmHg, and his pulse is regular at 80/min. The following are the results of his investigations:

Hb: 145 g/l (135-180)
WCC: 5.1×10(9)/l (3.8-10.8)
PLT: 221×10(9)/l (150-450)
Na: 147 mmol/l (135-145)
K: 5.1 mmol/l (3.5-5.5)
Bicarbonate: 27 mmol/l (18-28)
Cr: 125 micromol/l (60-110)
Glucose: 5.1 mmol/l (<7) What additional intervention is most likely to benefit this patient?

MRCP2-1588

A 67-year-old woman is experiencing worsening wheezing and shortness of breath. She has a history of asthma for the past 15 years and is currently taking inhaled salbutamol, inhaled fluticasone, and a daily dose of 15 mg of prednisolone. In the past, she has received multiple courses of prednisolone. Hormone replacement therapy (HRT) was also prescribed for one year to manage Postmenopausal symptoms, but it was discontinued after she developed a deep vein thrombosis. What medication would you recommend for osteoporosis prevention?

MRCP2-1557

A 29-year-old woman presents to the endocrinology clinic with multiple swellings in her neck. She was referred urgently by her GP after thyroid function tests showed an overactive thyroid. She has a past medical history of appendicectomy and asthma, and uses a salbutamol inhaler when she becomes unwell with viral and coryzal infections. However, she has been experiencing weight loss, tremor and amenorrhoea. During examination, several painful nodules were found in her goitre. She is worried about the possibility of having cancer. What aspects of her medical history suggest that malignancy is unlikely?

MRCP2-1573

A 38-year-old man comes to the endocrinology clinic for a follow-up appointment. He was previously investigated for hyperthyroidism and was asked to return for further evaluation by the consultant. The patient initially presented to the emergency department with palpitations and was diagnosed with atrial fibrillations. Further investigations revealed an undetectable TSH with a free T4 of 52 ng/dl. Since his discharge, he has been taking bisoprolol and apixaban, which have significantly improved his palpitations, but he still experiences them. On examination, there is no apparent neck swelling or tenderness. The patient returns with thyroid-stimulating hormone receptor antibodies that were tested and reported as undetectable. What is the next appropriate investigation?

MRCP2-1558

A 40-year-old woman visits the endocrine clinic with a lump on the left side of her neck that she has noticed for a few weeks. She is increasingly worried about it. Her vital signs are stable, and she has a pea-sized lump on the left side of her thyroid. The following are her test results: Hb 130 g/L (115-160), WCC 7.0 ×109/L (4-11), PLT 178 ×109/L (150-400), Na 139 mmol/L (135-146), K 4.2 mmol/L (3.5-5.0), Cr 112 µmol/L (79-118), and TSH 0.8 IU/L (0.5-4.5). What is the most appropriate next investigation?

MRCP2-1559

A 63-year-old woman arrives at the hospital with symptoms of agitation, nausea, vomiting, productive cough with green sputum, and chest pain. She is also confused and agitated. Upon examination, her heart rate is 150 bpm, blood pressure is 103/65 mmHg, temperature is 40.1º, and oxygen saturation is 94%. She has a medical history of myocardial infarction, polycystic ovaries, hypertension, and hyperthyroidism. She admits to poor compliance with treatment. She is supposed to take aspirin, atorvastatin, amlodipine, and carbimazole. Her blood tests are pending. What is the most indicative symptom of thyroid storm in this case?

MRCP2-1560

A 45-year-old woman complains of increasing neck discomfort for the past 2 months. She has no significant medical or family history. Upon examination, a solid neck mass is noted that moves with swallowing but not with tongue protrusion. Further evaluation with ultrasound and fine needle aspiration reveals a 2.5cm papillary thyroid cancer. A CT scan of the neck shows a solitary lymph node in the left anterior cervical chain. What is the best course of treatment?

MRCP2-1561

A 40-year-old Japanese man is brought to the hospital after collapsing at work. He reports experiencing palpitations and losing 6 kg of weight over the past six months. His GP prescribed venlafaxine for anxiety. During the examination, the patient displays significant proximal muscle weakness in both upper and lower limbs and is hyporeflexic. What treatment option is most likely to provide immediate relief for these symptoms?

MRCP2-1562

A 32-year-old man who works in a hospital presents for evaluation. He has been experiencing weight loss and palpitations, especially at night, for the past few months. His primary care physician has conducted a TSH test, which showed a level of <0.1 IU/l (0.5-4.5). During the examination, his blood pressure is 120/70 mmHg, and his pulse is 90 and regular. No goitre or nodules are palpable in his neck. Which of the following tests is most likely to distinguish between self-administration of thyroid hormone and endogenous causes of thyrotoxicosis?

MRCP2-1563

A 35-year-old patient presents to the ED with tremors, nervousness, and intolerance to heat. On examination, there is a small, smooth goitre on palpation of the neck. BP is 118/70 mmHg, while pulse is 92 bpm and regular. There is a fine tremor at rest and sweaty palms. Urea and electrolytes are normal. TSH level is < 0.01, and both T4 and T3 are elevated. Thyroid scanning shows a uniformly increased uptake of technetium. What is the most likely diagnosis based on these findings?