MRCP Part 2 Category: Endocrinology, Diabetes And Metabolic Medicine

MRCP2-1396

A 26-year-old female presents to the clinic with a worsening of fatigue that she has been experiencing for several months. She reports constipation, cold intolerance, and dry skin. She has no significant medical history and is not taking any regular medications. During examination, her lying blood pressure is 110/75 mmHg, which drops to 95/60 mmHg upon standing.

The following are the results of her investigations:

– Hemoglobin (Hb): 110 g/l
– Sodium (Na+): 131 mmol/l
– Fasting glucose: 7.5 mmol/l
– Platelets: 425 * 109/l
– Potassium (K+): 5.1 mmol/l
– Bicarbonate: 19 mmol/l
– White blood cells (WBC): 10.1 * 109/l
– Urea: 10.5 mmol/l
– Creatinine: 110 µmol/l

What is the most likely diagnosis?

MRCP2-1381

A 60-year-old man is hospitalized with pneumonia and hyponatraemia, presenting a sodium level of 116 mmol/l. He received antibiotics and rapid infusions of 3% hypertonic sodium chloride, but despite initial improvement, he suffered neurological deterioration with seizures and subsequent coma the next day. What could be the reason for his decline?

MRCP2-1382

A 20-year-old male has been referred to the endocrine clinic due to low libido and difficulty in forming sexual relationships. Upon examination, he is found to be tall, with a height of 6 feet 3 inches. His blood pressure is 122/82 mmHg, pulse is regular at 70 beats per minute, and his BMI is 21. He has a long arm span and sparse secondary sexual hair, with small testes measuring less than 5 ml bilaterally. The concern is his long-term risk of osteoporosis.

What would be the proposed management plan for this patient?

MRCP2-1383

You assess a 75-year-old male in the endocrine clinic who has been diagnosed with hypothyroidism for the past 20 years. He also has a medical history of dyslipidemia and chronic obstructive pulmonary disease (COPD). The patient is currently taking levothyroxine 125 mcg daily, atorvastatin 20 mg daily, budesonide/formoterol inhaler 2 puffs BD, and salbutamol inhaler PRN. The latest thyroid function tests reveal:

TSH 0.4 mIU/l
FT4 29 pmol/l

Based on these results, you decide to decrease the dose of levothyroxine. What is the potential danger of over-replacement with levothyroxine?

MRCP2-1384

What biochemical characteristic(s) are commonly seen in Paget’s disease?

MRCP2-1370

A 63-year-old woman presents with persistent hypertension and obesity, along with complaints of excessive pigmentation and headaches. In the 1970s, she underwent investigation for obesity, mild diabetes mellitus, and hypertension, which led to a bilateral adrenalectomy – the treatment of choice at the time. Since then, she has been on hydrocortisone and fludrocortisone treatment. On examination, she displays hyperpigmentation and striae, with a blood pressure reading of 175/100 mmHg. Visual fields appear normal. What is the probable diagnosis in this case?

MRCP2-1371

A 65 year-old woman presents with persistent hypertension and obesity, along with complaints of excessive pigmentation and headaches. She has a past medical history of investigation for obesity, mild diabetes mellitus, and hypertension in the 1970s, which led to a bilateral adrenalectomy. Since then, she has been on hydrocortisone and fludrocortisone treatment. On examination, she exhibits hyperpigmentation and striae, and her blood pressure is 175/100 mmHg. Visual fields appear normal. What is the most appropriate investigation to confirm the diagnosis?

MRCP2-1372

A 75-year-old woman was referred to the outpatient clinic by her GP. The GP’s note indicated that the patient had suffered a femoral neck fracture three months ago while walking. The fracture was treated with a dynamic hip screw. The patient was seeking treatment to strengthen her bones and prevent future fractures. Apart from a hysterectomy and bilateral oophorectomy at age 45 for severe menorrhagia, she had no significant medical history. Physical examination revealed no abnormalities. What is the most appropriate treatment option for this patient?

MRCP2-1373

A 50-year-old man has been prescribed 500mg metformin BD for his type 2 diabetes mellitus after failing to achieve his target HBA1c of 6.5% 6 months ago. He has come for his routine check-up and reports feeling well. He confirms that he has been adhering to his metformin regimen, maintaining a healthy diet, and exercising regularly. His latest HBA1c reading is 7.3%, and all other tests are normal. What is the next best course of action to manage his diabetes?

MRCP2-1374

A 59-year-old man with a history of type 2 diabetes mellitus and chronic heart failure is seen in the diabetes clinic. His current medications include metformin, gliclazide, ramipril, bisoprolol, furosemide, and simvastatin. His annual blood work shows normal electrolyte levels, kidney function, and cholesterol levels, but his HbA1c is 7.7%. His blood pressure is 124/78 mmHg and his BMI is 29 kg/m². What is the most appropriate course of action regarding his anti-diabetic medication?