MRCP Part 2 Category: Endocrinology, Diabetes And Metabolic Medicine

MRCP2-1659

A 20-year-old woman presents to the clinic with a 4-week history of increasing lethargy and weakness. She reports experiencing recurrent muscle cramps in her legs, which have been affecting her sleep. Additionally, she has been urinating up to ten times a day and feels constantly dehydrated. She also mentions that her periods, which were previously irregular, have ceased for the past 4 months.

During the examination, the patient is noted to be underweight, with a body mass index of 17kg/m². Her heart rate is 88 bpm, and her blood pressure is 108/86 mmHg.

The following laboratory results are obtained:

– C Reactive protein: 2 mg/l
– Haemoglobin: 158 g/l
– White cell count: 7.6 x 10^9/L
– Na+: 136 mmol/l
– K+: 2.9 mmol/l
– Urea: 7.2 mmol/l
– Creatinine: 108 µmol/l
– Corrected calcium: 2.42 mmol/l

A venous blood gas test reveals:

– pH: 7.532
– Bicarbonate: 37 mmol/l

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

MRCP2-1660

A 38-year-old female presents with 5 days of feeling generally unwell and recent dysuria. Her urine has a foul odor and is dark in color. She has a history of type 1 diabetes and has been on subcutaneous insulin for a long time. Upon admission, her pH was 7.24, bicarbonate was 8 mmol/l, and blood glucose was 32 mmol/l. Her urine dip showed 2+ leukocytes, 2+ nitrites, and 4+ ketones. She was started on treatment for diabetic ketoacidosis with intravenous fluids and fixed rate insulin, as well as intravenous antibiotics for a urinary source of sepsis. You are asked to review her blood sugars 4 hours after treatment initiation. What is the goal in managing hyperglycemia in a patient with diabetic ketoacidosis?

MRCP2-1645

A 42-year-old woman visits her primary care physician (PCP) complaining of occasional double vision when looking upwards. She experiences diplopia, most noticeable when looking to the right and looking downwards. Upon examination, she has mild bilateral proptosis and her eyes appear normal when looking straight ahead. Her pupils are equal and have normal direct and consensual light reflexes. She is able to look up and down for 10 seconds without any signs of fatigue. There is no weakness or fatigability in any peripheral muscles.
The following investigations were conducted:

Free Thyroxine FT4 16 pmol/l 11–22 pmol/l
Thyroid Stimulating Hormone (TSH) 2.8 µU/l 0.17–3.2 µU/l
What is the most probable diagnosis?

MRCP2-1661

A 36-year-old woman complains of fatigue, palpitations, and weight loss. As part of her diagnostic workup, thyroid function tests were conducted:

TSH <0.01mU/L 0.4-4.0mU/L
T4 15.3pmol/L 9.0-25.0pmol/L

What is the next most suitable test to perform for this patient?

MRCP2-1646

A 25-year-old woman with excessive hair growth and obesity presents to the Endocrinology Clinic with a prolactin level of 900 mU/l (normal range: 90–520 mU/l) and absence of menstrual periods for the past four months. On examination, her BP is 130/85 mmHg, pulse is 72 bpm and regular, and BMI is 35 kg/m2. What is the most crucial next step in her management?

MRCP2-1647

A 23-year-old man visits the endocrinology clinic with complaints of low energy and a low morning testosterone level. He recently moved to the UK from Albania and has been experiencing constant fatigue and a decrease in sexual desire since starting a new relationship. During the physical examination, he was observed to be tall and slim with mild gynaecomastia. What would be the most suitable investigation to perform after confirming the low morning testosterone level?

MRCP2-1648

A 27-year-old man with a history of Addison’s disease reaches out to his endocrinologist for advice. He has recently signed up for a marathon and is unsure about how to manage his hydrocortisone and fludrocortisone during the event. The patient is generally healthy and has no other medical conditions. He has experienced two hospitalizations in the past due to difficulties with taking hydrocortisone and now carries emergency doses of IM hydrocortisone. What guidance should the endocrinologist provide?

MRCP2-1649

A 29-year-old woman has been experiencing intolerance to cold weather, fatigue, and low mood without any apparent triggers for the past year. Upon physical examination, no abnormalities were found. Her ECG showed a sinus rhythm of 43 beats per minute. She has a medical history of type 1 diabetes mellitus and coeliac disease, for which she takes insulin. Her blood test results are as follows:

– Hb: 136 g/L
– MCV: 103 fL
– Na: 133 mmol/L
– K: 4 mmol/L
– Urea: 3.5 mmol/L
– Creatinine: 70 µmol/L
– Glycosylated haemoglobin (HbA1c): 51 mmol/mol (6.8%)
– TSH: 9.2 mIU/L (reference range 0.3-4.0 mIU/L)
– T3: 2 pmol/L (reference range 3-9 pmol/L)
– T4: 5 pmol/L (reference range 9-25 pmol/L)

What is the most appropriate next step in managing her condition?

MRCP2-1650

A 29-year-old female presents with a 3-day history of abdominal pain, a 6-day history of diarrhoea and vomiting and reduced appetite. She is a known type one diabetic with background diabetic retinopathy and stage 3 chronic kidney disease. She usually takes 30 units lantus at night and variable doses of Novomix with meals however due to her poor appetite she has not taken these for 3 days. On examination, she looks unwell. The airway is patent and chest is clear. Respiratory rate is 25/min with normal oxygen saturations on air. Pulse is 118/min and thready with a capillary refill of 3 seconds centrally. Blood pressure is 105/46 mmHg with a temperature of 36.8oC. Abdomen is generally tender without guarding. Capillary blood glucose is 27 and ketones are 5.1. Arterial blood gas is as follows:

pH 7.31
pO2 11.5 kPa
pCO2 3.35 kPa
Bicarbonate 14.2 mmol/l
Base Excess -6.8 mmol/l
Lactate 2.2 mmol/l

The patient is currently being fluid resuscitated appropriately. What form of insulin therapy would you recommend?

MRCP2-1651

A 50-year-old man presents to the endocrinology clinic with complaints of frequent headaches. He reports being awakened by the headaches at night, along with low energy, weight loss, low libido, and postural dizziness. Upon investigation, his full blood count is normal, but he has low free T4, low testosterone, low morning cortisol, low LH and FSH, and low TSH. An MRI reveals a possible pituitary adenoma. The patient is eager to begin treatment to improve his symptoms. However, which hormonal replacement therapy would be contraindicated in this immediate setting? The patient has no other medical conditions and does not take any regular medications.