MRCP Part 2 Category: Endocrinology, Diabetes And Metabolic Medicine

MRCP2-1406

A 45-year-old man presents to the Hypertension Clinic with a history of headaches and dizziness over the past four months. He also reports experiencing central abdominal discomfort and some recent weight loss, possibly due to a low-fat diet. On examination, his BP is 154/92 mmHg, and there is noticeable swelling in his thyroid. His bone profile shows a corrected calcium level of 2.76 mmol/l, and his GP has ruled out diabetes with a normal oral glucose tolerance test. What is the most likely cause of his hypertension?

MRCP2-1407

A 35-year-old man is brought to the Emergency Department (ED) by his family. He is convinced that his coworkers are plotting against him. His family reports that he has been sleeping very little and has been extremely agitated lately. He has no previous psychiatric history.
On examination, his blood pressure (BP) is 160/90 mmHg, with a pulse of 110 beats per minute (bpm) and no arrhythmia. Eye examination and thyroid palpation are normal.
Investigations reveal the following:

Haemoglobin (Hb) 140 g/l 130–170 g/l
White cell count (WCC) 6.2 × 109/l 4.0–11.0 × 109/l
Platelets (PLT) 200 × 109/l 150–400 × 109/l
Sodium (Na+) 142 mmol/l 135–145 mmol/l
Potassium (K+) 4.5 mmol/l 3.5–5.0 mmol/l
Creatinine (Cr) 80 μmol/l 50–120 µmol/l
Thyroid-stimulating hormone (TSH) 0.01 µU/l 0.17–3.2 µU/l
T4 28.5 pmol/l 11–22 pmol/l
Anti-thyroglobulin antibody +
What is the most likely diagnosis?

MRCP2-1408

A 35-year-old woman visits his primary care physician (PCP) complaining of fatigue. She is currently taking fluoxetine for postnatal depression, her child now being five months old. She has a past medical history of hypertension, which is well-controlled with medication. Her thyroid function tests reveal a TSH of 6.5 mU/l (normal range: 0.4-5.0 mU/l) and a free T4 of 9.5 pmol/l (normal range: 10-22 pmol/l). Anti-TPO antibodies are positive.
What is the most accurate prognosis for this patient?

MRCP2-1409

A 35-year-old female presents with complaints of tiredness and poor appetite. She gave birth to a healthy baby 3 months ago and is currently breastfeeding. During her pregnancy, she required iron for anaemia but is otherwise healthy and takes no medications. There is no significant family history. On examination, she has a BMI of 24 kg/m2, a pulse of 96 beats per minute, and a blood pressure of 124/70 mmHg. A small goitre is palpable, but no bruit is audible. She has a slight tremor of her outstretched hands. Cardiovascular, respiratory, and abdominal examinations are normal. Investigations reveal a haemoglobin level of 105 g/L (115-165), an ESR (Westergren) of 21 mm/1st hour (0-20), and abnormal thyroid function tests with elevated T4 and T3 levels and a low TSH level. What is the most likely diagnosis?

MRCP2-1410

A 46-year-old man is admitted to the psychiatric ward due to experiencing visual hallucinations for the past two days. He has a medical history of membranous glomerulonephritis and underwent a renal transplant last year. He is currently taking immunosuppressants.

Upon examination, there are no signs of focal neurology. The patient’s cranial nerves I to XII are normal, with reactive pupils that are equal in size. There are no cerebellar signs, but the plantars are equivocal on the left and downgoing on the right. The patient’s AMTS score is 8 out of 10. An urgent CT head scan shows no abnormalities.

Which medication could be a possible cause of the patient’s symptoms?

MRCP2-1397

A 32-year-old female patient presents to her GP with concerns about excessive hair growth. She is also struggling to conceive and has been diagnosed with PCOS due to her ultrasound showing polycystic ovaries. Her weight is above average and she has acne. What hormone excess is responsible for her hirsutism?

MRCP2-1398

What is the primary reason for hyperandrogenism in women who are in their reproductive years?

MRCP2-1399

A 17-year-old boy is referred to the Endocrinology Clinic. He presents with short stature (less than the lower 3rd centile) and his weight is between the 10th and 15th centiles.
Upon examination, he has no pubic hair and pre-pubertal testes. There is no family history and he is currently well except for a three-month history of headaches. The patient undergoes appropriate investigations and imaging studies, and the result of the CT scan of the head reveals the presence of a suprasellar calcified cyst with the cyst content having the same density as the cerebral spinal fluid (CSF).
What is the most probable diagnosis?

MRCP2-1400

A 55-year-old obese man presented to the emergency department with central chest pain, sweating, shortness of breath, and pallor. He was diagnosed with a STEMI and underwent primary PCI. An ECHO revealed an EF of 35% after the event. Further investigation for his coronary artery disease led to a diagnosis of type 2 diabetes. He was given iv insulin, which controlled his blood glucose temporarily.

Lab Results:

– Creatinine: 122 umol/L
– Urea: 8.2mmol/l
– Na+: 140 mmol/l
– K+: 3.6 mmol/l
– eGFR: 62 ml/min
– HbA1C: 9.4%
– HCO3: 22
– Aspartate transaminase: 52 U/L
– Alkaline phosphatase: 110 U/L
– Gamma-glutamyl transferase: 39 U/L

Which hypoglycemic agent should be avoided in the long-term treatment of his diabetes?

MRCP2-1385

A 75-year-old man presents to his GP with left flank pain and intermittent sweats that improve with eating. He has also fainted between meals. A technically difficult ultrasound reveals a 3 cm mass in the tail of the pancreas. A CT scan confirms the mass and blood biochemistry is normal. A blood glucose test after an overnight fast and exercise bike session shows a reading of 2 mmol/l. A CT guided needle biopsy of the pancreas shows ill-defined nests of cells that stain positive for chromogranin and synaptophysin. What is the most likely diagnosis?