MRCP Part 2 Category: Endocrinology, Diabetes And Metabolic Medicine

MRCP2-1527

A 35-year-old female patient visits her GP complaining of frequent headaches, excessive sweating, reduced peripheral vision, deepening of her voice, and absence of menstrual periods. She has also noticed an enlargement of her lower jaw. Upon examination, mild hirsutism is observed. Visual tests reveal bitemporal hemianopia. Diagnostic tests show a fasting blood glucose level of 7.8 mmol/l and a 2-hour post-prandial value of 12.5 mmol/l. Prolactin levels are elevated at 1000. Her BP is high at 165/99 mmHg. An MRI scan shows a 20 mm pituitary adenoma. What would be the most appropriate initial management for this case?

MRCP2-1528

A 29-year-old woman who is 11 weeks pregnant presents for evaluation. This is her second pregnancy. She had gestational diabetes during her first pregnancy, which resolved after her son’s birth. What is the best course of action at this point?

MRCP2-1529

A 56-year-old woman presents to the emergency department with sweating and palpitations. She has a past medical history of Graves disease. She has completed a course of carbimazole approximately six months ago. Her other past medical history includes type 2 diabetes, hypertension, ischaemic heart disease and morbid obesity. She is on metformin, aspirin, amlodipine and atorvastatin.

Her observations are as follows:

Heart rate 111 beats per minute
Blood pressure 124/72 mmHg
Respiratory rate 21/minute
Oxygen saturations 96% on room air
Temperature 37.1C

On examination, she is diaphoretic and anxious. A tremor is noted. Ophthalmic examination is normal. There is a very small goitre. Her body mass index is 53 kg/kg/m².

Blood tests:

TSH 0.0 mIU/L (0.2-5.5)
Free T4 42 pmol/L (10 – 24.5)

What is the most appropriate treatment plan for addressing the underlying cause of this likely diagnosis?

MRCP2-1530

A 56 year-old man presents with a three month history of weight loss and a two week history of increasing confusion. His partner reports that his clothes are now loose on him and that he has started to forget things and that he has been unable to reach for objects off the top shelf at the supermarket over the last three months due to increasing weakness. Seven weeks ago he had been treated for an islet cell carcinoma of the pancreas with chemotherapy and has no other past medical history.

Examination reveals an abbreviated mental test score of 5/10 and weakness in the shoulders and getting out of the chair. Heart sounds 1 and 2 are present with no added sounds, his chest is clear and the abdomen is soft and non-tender.

Observations reveal a blood pressure of 158/95 mmHg, a pulse rate of 90 beats per minute, a temperature of 37.5ºC and a respiratory rate of 14 breaths per minute. Random blood glucose is 16.2 mmol/L.

Blood tests are performed and reveal:

Hb 14.2 g/l
Platelets 180 * 109/l
WBC 4.9 * 109/l
Na+ 150 mmol/l
K+ 2.6 mmol/l
Urea 5.2 mmol/l
Creatinine 100 µmol/l
Bilirubin 15 µmol/l
ALP 70 u/l
ALT 28 u/l
γGT 47 u/l
Albumin 48 g/l

What is the most likely diagnosis?

MRCP2-1531

A 45-year-old woman discovered a lump in her neck that was palpable in the right lobe of her thyroid gland. She was clinically euthyroid.

TSH 2.8 (NR 0.4-5.0)
free T4 14.5 (NR 10-25)
corrected calcium 2.39 (NR 2.2-2.6)

USS: 1.8 x 1.5cm solid lesion in right lobe of thyroid with microcalcification.

What should be the next step in managing this case?

MRCP2-1532

A 25-year-old female presents to the Emergency department with her concerned parents. They report that their daughter has been displaying increasingly aggressive behavior and has become suspicious of them. She believes that her neighbors are plotting against her because they dislike her. Additionally, she has been accusing her friends of trying to steal her boyfriend, causing many arguments. The parents attribute these symptoms to their daughter’s strict diet for a sports competition. The patient is alert and oriented to time, place, and person, with no significant medical history or medication use. On examination, she appears healthy, except for nodulocystic acne on her face and back. What is the most probable cause of this patient’s unusual behavior?

MRCP2-1533

A 42-year-old woman is referred to the outpatient department by her GP due to recurrent urinary tract infections that have not responded to treatment with trimethoprim and nitrofurantoin over the past six months. She is now experiencing painful urination and difficulty urinating. The patient has a history of type 2 diabetes mellitus, and despite completing a course of amoxicillin, she still complains of pain on urination and lower abdominal pain. Her family has a history of type 2 diabetes mellitus, and she has a smoking history of 5 pack years and drinks an average of 15 units per week. An HbA1c test shows a result of 82 mmol/mol. What is the most likely organism responsible for the recurrent urinary tract infections?

MRCP2-1534

A 50-year-old woman was admitted to the hospital with chest pain that sounded cardiac in nature. Her body mass index was 34 kg/m2, and she had a history of type 2 diabetes mellitus and hypertension. After being treated for stable angina, she expressed interest in learning more about obesity and potential treatment options.

What is the most suitable treatment option for her obesity at this point?

MRCP2-1535

A 45-year-old woman presents to the hospital with a complaint of breast swelling for the past three days. She has no other medical issues and is diagnosed with a breast abscess, which is drained and treated with antibiotics. During her hospital stay, her corrected calcium (2.79 mmol/L) and parathyroid hormone (9.5 pmol/L) levels are found to be elevated.

Upon review by the endocrine team, she is asymptomatic and physical examination is unremarkable. Further tests reveal normal vitamin D levels, 24-hour urine calcium, and DEXA scan. She is advised to follow up with her GP for annual blood tests to monitor her calcium levels and renal function.

The patient is ultimately diagnosed with primary hyperparathyroidism. What additional investigations should be recommended for monitoring purposes?

MRCP2-1536

A 50-year-old female patient visits the clinic complaining of right-sided flank pain. A CT KUB scan confirms the presence of a kidney stone on the right side. The patient has a medical history of asthma, rheumatoid arthritis, and Sjögren’s syndrome. She is currently taking salbutamol, methotrexate, and hydroxychloroquine.

The patient’s blood test results show a hemoglobin level of 115 g/l, platelet count of 460 * 109/l, bicarbonate level of 16 mEq/L (normal range is 22-28), urea level of 7.8 mmol/l, chloride level of 115 mmol/l, and creatinine level of 76 µmol/l.

What measures can be taken to prevent the formation of further kidney stones?