MRCP Part 2 Category: Endocrinology, Diabetes And Metabolic Medicine

MRCP2-1521

A 35-year-old woman presents to the endocrinology clinic with a 3-week history of intermittent headaches and milky discharge from her nipples. She also reports missing her menstrual periods for the past 6 months despite having a regular 28-day cycle. The patient has no significant medical history and no known allergies.

Lab results:

– Thyroid-stimulating hormone (TSH): 0.6 mU/L (0.5-5.5)
– Free thyroxine (T4): 8.2 pmol/L (9.0-18.0)
– Adrenocorticotrophic hormone: 8 ng/L (0-47)
– Insulin-like growth factor 1 (IGF-1): 11 nmol/L (12.4-30.3)
– Prolactin: 5500 IU/mL (59-619)
– β-HCG: <1 u/L (<1) An MRI of the head reveals a pituitary adenoma measuring approximately 1.5cm, which is compressing the optic chiasm. What is the most appropriate next step in managing this patient’s likely diagnosis?

MRCP2-1537

A 29-year-old woman presents with flu-like symptoms, palpitations and pain over the anterior neck over the past 2-3 weeks. She has also suffered rapid weight loss and feels increasingly anxious that there may be something seriously wrong with her. Her thyroid-stimulating hormone has been measured at <0.05 IU by her GP. On examination her blood pressure is 128/82 mmHg, her pulse is 95 beats per minute and regular, and she has a fine tremor. There is mild tenderness over the anterior neck. Body mass index is 22 kg/m². What other symptoms would you expect to observe in this patient?

MRCP2-1522

A 32-year-old woman with a history of epilepsy visits her primary care physician for a check-up. She has recently started taking carbamazepine after experiencing more frequent seizures. Over the past week, she has been experiencing worsening fatigue, headaches, and occasional confusion, as reported by her partner. What is the most likely diagnosis based on these symptoms?

MRCP2-1523

A 28-year-old nulligravida woman presents to her GP with a complaint of not having menstruation for 6 months. She had irregular periods from age 14-16 and then took oral hormonal contraception until last year when she got married. The patient is adopted and does not know her family history. She is physically fit, enjoys recreational running, and maintains a healthy diet. She does not smoke, drink, or use illicit drugs. Her vital signs are normal, and her body mass index is 22 kg/m².

On physical examination, no abnormalities are found, and a urine pregnancy test is negative. What is the most appropriate screening test for this patient?

MRCP2-1524

A 63-year-old man presents to the Emergency department with persistent nausea and vomiting for the past 3-4 weeks. He has a history of Type 2 diabetes for the past 8 years and is currently on a medication regimen of metformin, sitagliptin, and empagliflozin. He reports a recent weight loss of approximately 6kg. On examination, his blood pressure is 112/68 mmHg, his pulse is regular at 86 beats per minute. Laboratory results show elevated ketones and a glucose level of 12.5 mmol/l.

What is the most appropriate approach to managing his glucose control?

MRCP2-1509

You are asked to assess a 42-year-old man who has developed a fever and tachycardia after undergoing surgery. He is previously healthy, a non-smoker, and drinks alcohol only occasionally. The patient had a fall the previous night resulting in a distal radius fracture and underwent open reduction and internal fixation under general anesthesia. During the procedure, he received 4mg ondansetron and 8 mg dexamethasone for postoperative nausea and 10mg morphine for pain relief. He denies feeling unwell and has no symptoms suggestive of an intercurrent infection.

Upon examination, the patient’s heart rate is 130 beats/min and irregular, his blood pressure is 135/74 mmHg, and his temperature is 39.4ºC. His chest is clear to auscultation, his abdomen is soft and non-tender, and there is no rash or meningism. His right forearm is in plaster, but is not particularly painful, and his fingers are warm with normal sensation.

Lab results show Hb 130 g/l, platelets 460 * 109/l, WBC 10.5 * 109/l, Na+ 138 mmol/l, K+ 4.1 mmol/l, urea 5.1 mmol/l, creatinine 95 µmol/l, C-reactive protein 1 mg/L, thyroid stimulating hormone <0.02 mIU/L, and cortisol 45 µg/dL. What is the most appropriate initial treatment?

MRCP2-1510

A 23-year-old female presents with a 10-week history of nausea, constipation, and fatigue. She has no past medical history and takes no regular medications. Blood tests reveal a hemoglobin level of 110 g/l, platelet count of 422 * 109/l, and white blood cell count of 8.2 * 109/l. Thyroid function tests show normal TSH levels but elevated total T4 levels. What further investigation would you recommend?

MRCP2-1511

A 35-year-old man presents to the ED with a severe headache after chasing a car thief. He has a history of normal health and stature, but is found to be hypertensive with a BP of 165/90 mmHg, which later settles to 155/85 mmHg. Upon further questioning, it is discovered that his mother passed away at an early age from thyroid cancer, and his GP found elevated calcium levels of 2.84 mmol/l during routine blood work after he moved house a few months ago. What is the likely underlying diagnosis for his symptoms?

MRCP2-1512

A 25-year-old woman presents to the hospital after collapsing while shopping. Upon examination, her temperature is 37.2°C, her pulse rate is 78 per minute and regular, and her blood pressure is 164/92 mmHg. Heart sounds 1 and 2 are present with no added sounds, and her chest is clear on auscultation. Her abdomen is soft and non-tender with no organomegaly. Neurological examination is unremarkable. She has no significant medical history and is not taking any regular medications.

Further blood tests reveal low renin and aldosterone levels, hypokalaemia, and a serum bicarbonate of 30 mmol/l.

What is the most appropriate treatment for her condition?

MRCP2-1513

A 28-year-old female presents to the Emergency Department after collapsing without any warning signs. She reports waking up on the ground, face down. She has been experiencing general weakness, dizziness, and intermittent palpitations, which she recently discussed with her GP. Her medical history includes hypothyroidism and rheumatoid arthritis, which were previously managed with infliximab. Three months ago, she was diagnosed with TB, and she is currently taking methotrexate, folic acid, levothyroxine, artificial tears, rifampicin, and isoniazid.

During the examination, the patient complains of recurrent palpitations, and the cardiac monitor shows broad-complex tachycardia. Her blood pressure is stable at 117/68 mmHg, and she is given a bolus of amiodarone. Her venous blood gas reveals metabolic abnormalities, including a pH of 7.31, pCO2 of 4.3 kPa, and HCO3 of 15.6 mmol/l, among others. Additional investigations, such as a urine dipstick and chest and abdominal X-rays, are requested.

What is the most likely cause of the patient’s metabolic abnormalities?