MRCP Part 2 Category: Endocrinology, Diabetes And Metabolic Medicine

MRCP2-1572

A 35-year-old patient with Addison’s disease presents for follow-up at the endocrinology clinic. The patient was diagnosed with Addison’s disease six months ago and has been prescribed 20mg of hydrocortisone in divided doses and 50micrograms of fludrocortisone. The patient reports occasional fatigue but is otherwise feeling well. The patient has a history of hypothyroidism and is currently taking 100 micrograms of levothyroxine, with recent TSH levels indicating good thyroid function.

What tests can be conducted to evaluate the adequacy of glucocorticoid replacement therapy?

MRCP2-1541

A 45-year-old woman with a history of anemia and epilepsy presents to the endocrinology clinic with symptoms of fatigue, weight loss, abdominal pain, nausea, and vomiting. She is not currently taking any steroids. Upon examination, there are no signs of abnormal pigmentation. After receiving 250µg of synacthen injection at 9 am, a series of cortisol measurements are taken:

– Baseline cortisol: 190 nmol/L (>180 nmol/L)
– Cortisol at 30 minutes: 390 nmol/L (>420 nmol/L)
– Cortisol at 60 minutes: 520 nmol/L (>420 nmol/L)

What would be the most appropriate next step in investigating this patient’s condition?

MRCP2-1542

A 23-year-old Asian woman with a body mass index of 24 kg/m² comes to the clinic complaining of new onset acne, hirsutism, and weight gain. She reports having irregular periods for the past two years. Upon examination, mild acne and thick hair growth are observed on her chin and areola region. Abdominal examination is normal.

What are the expected biochemical findings based on the presented clinical features?

MRCP2-1543

A 25-year-old female presents with worsening acne and hirsutism over the past 3 years. She had her first period at age 11 and experiences irregular periods.

During examination, her body mass index is 29 kg/m², heart rate is 80/min, and blood pressure is 135/85 mmHg. Mild clitoromegaly, hirsutism, and acanthosis nigricans are observed.

Blood tests on the 6th day after menstruation reveal:
– Estradiol: 300 pmol/L (NR<300 pmol/L)
– 17 OH-progesterone: 20 nmol/L (NR<10 nmol/L)
– Free Testosterone: 3 nmol/L (NR<3 nmol/L)
– LH: 4 IU/L (NR 1-9 IU/L)
– FSH: 3 IU/L (NR 1-13 IU/L)
– 9am cortisol: 150 nmol/L (NR 200-700 nmol/L)

What is the most useful single test?

MRCP2-1544

A 61-year-old man with unpredictable type 2 diabetes mellitus is seen at a local diabetic clinic. Despite making changes to his lifestyle and diet, his blood sugar levels remain high while taking first-line oral hypoglycemic medication. The physician in charge of his diabetes care decides to initiate dapagliflozin 10 mg once daily.

What is a typical adverse effect of dapagliflozin that the patient should be advised about?

MRCP2-1545

An 80-year-old man with type 2 diabetes mellitus presents to the diabetes clinic. He is currently on metformin 1g bd and has a history of hypertension and hypothyroidism. His HbA1c was 44 mmol/mol (6.2%) one year ago and is now 46 mmol/mol (6.4%). What would be the most suitable course of action for his management?

MRCP2-1546

A 54-year-old man with a history of hypertension comes in for his annual check-up. During the check-up, he undergoes a U&E, HbA1c, and cholesterol test. The results are as follows:

Blood pressure: 130/80 mmHg. He takes ramipril 5mg once daily.

Sodium: 141 mmol/l
Potassium: 4.5 mmol/l
Urea: 5.0 mmol/l
Creatinine: 90 µmol/l
Total cholesterol: 5.5 mmol/l
HbA1c: 44 mmol/mol (6.2%)

Based on his 10-year QRISK2 score, which is 8%, what is the most appropriate course of action following these results?

MRCP2-1547

You are asked to assess a 42-year-old female who has been receiving treatment for diabetic ketoacidosis for the past 48 hours. She has been experiencing abdominal discomfort and diarrhoea for the last 12 hours and has now become increasingly confused with visual hallucinations and aggressive behaviour.

The patient has a medical history of type 1 diabetes mellitus and Grave’s disease, which has been in remission and not requiring treatment.

Upon examination, the patient has generalised abdominal pain, mild pitting oedema, and an irregularly irregular pulse. Her observations show a respiratory rate of 18 breaths per minute, heart rate of 145 beats per minute, blood pressure of 170/110 mmHg, and a temperature of 40.2ºC. Her blood tests show elevated CRP levels and an abnormal thyroid function test.

What is the most appropriate acute treatment for the likely underlying cause of this patient’s current presentation?

MRCP2-1548

A 35-year-old female patient presents with weight loss and agitation for the past two months. Her general practitioner noted mild tachycardia, fine tremor, lid lag, and a small goitre during examination. Blood tests revealed elevated serum free T4 levels and low serum TSH levels. The GP started the patient on carbimazole 40 mg per day and referred her to the clinic. Two weeks later, the patient reports a sore throat but is otherwise well. Further investigations show abnormal blood counts. What is the most appropriate treatment strategy for this 35-year-old female patient?

MRCP2-1549

A 50-year-old male visits his primary care physician complaining of sweating, fatigue, and daytime exhaustion that have been ongoing for 2 months. He believes his wedding ring is tight due to fluid retention, and in the past 2 weeks, he has noticed his vision deteriorating and experiencing more severe headaches. He has no medical history and is not taking any regular medications.

What signs or symptoms would be consistent with the above presentation?