MRCP Part 2 Category: Endocrinology, Diabetes And Metabolic Medicine
MRCP2-1550
A 35 year-old man presents to the emergency department after collapsing at home. He has no recollection of the event but family members report no incontinence or seizures. The patient has no significant medical history and takes no regular medications.
On examination, his blood pressure is 160/95 mmHg, pulse is 72 beats per minute, respiratory rate is 18, and temperature is 37.2ºC. Cardiovascular and respiratory exams are unremarkable, and his abdomen is soft and non-tender.
What is the most appropriate treatment for this patient?
MRCP2-1551
A 49-year-old plumber presented with similar symptoms to the builder in the previous case. He complained of paraesthesia in both hands, worse at night, and a feeling of swelling in his hands. He also reported weakness in his hands while working. He had noticed increased urinary frequency, fatigue, and thirst over the past six months.
The patient had a history of hypertension and obesity, and his brother had type II diabetes mellitus. He was taking ramipril and had a 25 pack year history of smoking.
On examination, there was weakness of thumb abduction bilaterally and decreased sensation over the radial three and a half digits. Percussion over the palmar aspect of the wrist reproduced the paraesthesia. The patient had areas of pigmentation in both axillae and striae over the abdomen. He had a protuberant abdomen and an elevated BMI.
Which investigation is most likely to provide a diagnosis for this patient?
MRCP2-1552
A 35 year old man presents to the Emergency Department with tiredness and dizziness (worse on standing) which has been ongoing for the past few months. He had a past medical history of epilepsy and mentions that he has had ‘brain surgery’ in the past. He is on some medications but cannot remember the names. He has no allergies.
On assessment, he has no focal neurological deficit and cardiovascular/respiratory examination is normal. Observations show a blood pressure of 135/90 mmHg (dropping to 105/82 mmHg on standing), a heart rate of 67 beats per minute, a temperature of 36.2 degrees, oxygen saturations of 94% on air and a respiratory rate of 18/min. Given his medical history, you opt to keep this gentleman in the short stay unit for observation overnight.
What is the most likely underlying diagnosis based on the given information?
MRCP2-1553
A 51 year old man presents to his GP for a routine check-up. He has a medical history of hypertension which has been managed with ramipril for the past 3 years. During the check-up, the GP notes that the patient has been experiencing low back pain for the past few weeks, which has been relieved with over-the-counter paracetamol and ibuprofen. The patient’s blood pressure is 136/78 mmHg. As part of the check-up, blood tests are ordered and the results are as follows:
Upon seeing these results, the GP immediately refers the patient to the local Medical Assessment Unit for further testing. The following tests are carried out:
A 50-year-old woman presents with symptoms of tiredness, weight loss, anxiety, and difficulty sleeping. She had been receiving a combined cyclical oestrogen/progesterone hormone replacement therapy. Upon examination, she appeared thin with a pulse of 110 beats per minute, a fine tremor, and proximal myopathy. Her spleen tip was barely palpable. Initial investigations revealed elevated serum total thyroxine and low plasma TSH levels, as well as elevated alkaline phosphatase and gamma glutamyl transferase levels. The patient was started on carbimazole and propranolol, which resulted in a euthyroid state after six weeks. However, after a year of treatment, the patient reported increasing fatigue and was referred to the medical outpatient. Two weeks prior to her appointment, she developed a chest infection and was prescribed erythromycin. At the clinic, her alkaline phosphatase levels had decreased, but her thyroid function tests showed low serum total thyroxine and high plasma TSH levels. What is the cause of her elevated alkaline phosphatase?
MRCP2-1554
A 42-year-old woman presents with a recent history of weight loss and anxiety. She had been diagnosed with thyrotoxicosis three years ago and had been treated with carbimazole, but failed to attend follow-up appointments for over a year. Although she felt better after the treatment, she still had a goitre. Recently, she noticed a more prominent swelling on the right side of her neck and experienced symptoms of anxiety, along with a 3 kg weight loss. She is currently not taking any medication but is a smoker of 10 cigarettes daily.
During the examination, the patient had a pulse of 96 beats per minute, a fine tremor of the outstretched hands, lid lag, and some periorbital puffiness. There was a moderately enlarged and diffuse goitre with a more prominent 3 cm nodule on the left of the gland, which was non-tender. A bruit was heard over the goitre, and no lymphadenopathy was palpable. No other abnormalities were noted.
The investigations revealed a free T4 level of 37.3 pmol/L (10-22), a TSH level of 0.05 mU/L (0.4-5), and thyroid peroxidase antibodies of 1:2400 U/L. The I123 uptake scan showed diffuse uptake with no uptake in the left nodule. What is the most likely cause of the thyroid nodule?
MRCP2-1539
A 56-year-old woman with a history of sarcoidosis presents to the clinic with complaints of increased thirst, polyuria, and nausea. She recently returned from a trip to the Spanish Riviera and admits to consuming a lot of soft drinks. Her usual symptoms of mild shortness of breath and dry cough from sarcoidosis remain unchanged.
Upon investigation, her hemoglobin, white cell count, and platelets are within normal range. However, her sodium, potassium, and creatinine levels are elevated, and her calcium level has increased from her previous clinic visit.
What is the likely cause of the increase in her serum calcium?
MRCP2-1540
What is the hormone responsible for fetal lung maturation?
MRCP2-1525
A 32-year-old man is referred to the clinic by his primary care physician, having been experiencing fatigue and dizziness for several weeks. On examination, his BP is 110/70 mmHg, pulse is 80/min. His BMI is 22. He has calluses on his knuckles, but tells you these are due to his job as a mechanic.
What is the most likely diagnosis for this patient?
MRCP2-1526
A 70-year-old patient was referred to the emergency department after being found unresponsive in her home. She had a history of chronic obstructive pulmonary disease and had been on antibiotics for a chest infection. She had not been seen for the preceding 24 hours. She had a past medical history of hypertension and hyperlipidemia.
Her medication included Salbutamol, Ipratropium, Prednisolone, Atorvastatin, and Amlodipine.
Her initial examination revealed a blood pressure of 110/60 mmHg, heart rate of 95 beats per minute, respiratory rate of 22, and oxygen saturation of 92% on air. She had wheezing on both lung fields. She had sunken eyes, capillary refill time of three seconds, and no lower limb swelling. Her Glasgow coma scale was 14 out of 15.
The patient was treated with oxygen, intravenous antibiotics for a chest infection, and nebulized bronchodilators. They were also treated with intravenous fluids and insulin sliding scale as per the local diabetic ketoacidosis protocol.