MRCP Part 2 Category: Endocrinology, Diabetes And Metabolic Medicine

MRCP2-1476

A 26-year-old female presents with one week of progressive and persistent double vision. She reports increasing tiredness at all times of day over the past 2 months and occasional chest tightness associated with palpitations. She has no past medical history. She was also adopted and unaware of any family history.

During examination, a loss of left eye abduction, right eye upwards gaze, and right eye adduction are observed. Systemic examination also reveals bilateral clammy hands and a heart rate of 120 per minute, irregular. What is the most likely diagnostic test?

MRCP2-1461

A 25-year-old man is admitted with diabetic ketoacidosis. He is typically managed with basal bolus insulin but has missed several doses due to a busy work schedule. During examination, his respiratory rate is 30/min, he appears lethargic, disoriented, and has a distinct smell of acetone.
What arterial blood gas results would be most consistent with his presentation?

MRCP2-1462

A 50-year-old man presents with acute abdominal pain and a distended abdomen. He was given one litre of Hartmann’s solution in the Emergency Department. Upon examination, his pulse is 120 bpm, blood pressure is 70/40 mmHg, temperature is 39°C, and oxygen saturation is 93% on high-flow oxygen. He is also anuric. Arterial blood gases reveal a pH of 7.22, Base Excess of −13.5 mmol/L, lactate of 6.5 mmol/L, and K+ of 5.9 mmol/L. What should be the top priority in his immediate management?

MRCP2-1463

A 16-year-old female presents at the clinic for evaluation. Her 13-year-old sister was recently diagnosed with type 1 diabetes, and she is concerned about her own risk of developing the condition.

What is the most closely associated feature with the impending onset of type 1 diabetes?

MRCP2-1464

What is the proper procedure for conducting the oral glucose tolerance test (OGTT) to diagnose diabetes?

MRCP2-1465

A 75-year-old male is admitted acutely unwell.

Four weeks prior to admission he had presented to the GP with tiredness and weight loss and had been diagnosed with hypothyroidism based on results which showed:

T4 8.2 pmol/L (10-22)

TSH 5.2 mU/L (0.4-5)

He was treated with thyroxine 75 micrograms daily and has since deteriorated. He has no other past medical history of note, does not smoke and drinks modest quantities of alcohol. He is married and is self-caring. His father had hypothyroidism.

On examination, he is drowsy, thin, has a temperature of 37.8°C, a pulse of 102 beats per minute and a blood pressure of 90/60 mmHg. Cardiovascular, respiratory and abdominal examination are otherwise normal. There are no neurological abnormalities.

The house officer has sent some emergency bloods on this patient.

Whilst awaiting the results, what is the most appropriate immediate treatment for this patient?

MRCP2-1466

A 16-year-old girl is brought to the emergency department by her mother, appearing terrified after experiencing her second episode of being unable to move upon waking in the morning. She reports no loss of consciousness and has no documented past medical history. Neurological examination is normal, and her body mass index is 19.5 kg/m². An ECG shows a jerky baseline with flat T waves. What is the likely diagnosis?

MRCP2-1467

A 70-year-old female presents with 4 days of general decline following a recent urinary tract infection, treated with oral antibiotics in the community by the GP. She is known to be a type 2 diabetic, diagnosed 26 years ago and insulin dependent for the past 5 years. She is normally on 48 units Lantus, 24 units TDS Novorapid.

On examination, she is disoriented in time and place, with a GCS of 14/15. There is no focal neurology, and chest and cardiovascular auscultation are unremarkable. Suprapubic tenderness is demonstrated on deep palpation, but the abdomen is otherwise soft and non-tender, with present bowel sounds. She appears extremely dehydrated, with dry mucous membranes, cool peripheries, a capillary refill time of 4 seconds, and JVP +1 cm above the angle of Louis.

Her blood sugar is 31 mmol/L, and a venous blood gas demonstrates pH 7.22, lactate 2 mmol/l, and ketones 5 mmol/l. A urine dip is awaited. What is the most likely diagnosis?

MRCP2-1468

A 15-year-old male presents with chronic headaches and visual blurring lasting for 4 months. He has no past medical history and no known family history. On examination, his heart sounds are normal with no added sounds and the respiratory examination is unremarkable. He has no focal neurological signs. Fundoscopy reveals papilloedema, hard exudates and flame haemorrhage. His blood pressure is 230/160 mmHg. His blood tests and arterial blood gas are as follows:

Na+ 145 mmol/l
K+ 2.8 mmol/l
Urea 5.2 mmol/l
Creatinine 70 µmol/l

pH 7.50
PaO2 13.2kPa
PaCO2 3.3 kPa
Bicarbonate 35 mmol/L

Serum ambulatory renin activity 0.3 pmol/L @ 3-4 hours (normal range 0.8-3.5 pmol/ml/hr)
Serum ambulatory aldosterone 25 pmol/L@ 3-4 hours (normal range 100-800)

What is the recommended long-term treatment for this patient?

MRCP2-1469

A 54-year-old male presents with a nine-month history of poor concentration, weight gain, and fatigue. He had a pituitary tumor resected three years ago and has been taking hydrocortisone 10 mg twice daily and thyroxine 150 mcg daily since then. On examination, there are no significant findings. Laboratory tests reveal a serum free T4 level of 12 pmol/L, a serum TSH level of <0.05 mU/L, a serum testosterone level of 7.3 nmol/L (normal range 10-30), and an IGF-1 level of 8.9 nmol/L (normal range 10-35). What is the most appropriate treatment for this patient?