MRCP Part 2 Category: Endocrinology, Diabetes And Metabolic Medicine
MRCP2-1375
A 39-year-old woman presents to the Endocrine Clinic with a complaint of excessive sweating and occasional fever for the past six months. She recently went on a trip to Thailand but had to cut it short due to the unbearable heat. She has also noticed a gradual weight loss over the past year, despite having a good appetite. Upon examination, she is tachycardic but afebrile. Her palms are sweaty, and there is no palpable goitre or cervical lymphadenopathy. Routine FBC, U&E, and LFT are within normal limits. What is the most probable diagnosis?
MRCP2-1376
A 25-year-old woman has been experiencing hirsutism for the past six years, with coarse dark hair appearing under her chin. As a nurse, this has been causing her significant distress. She has attempted to manage the symptoms with shaving and depilatory creams, but has not found a lasting solution. Her menstrual cycle is irregular, with oligomenorrhoea, and she began menstruating at the age of 13. She has not yet become pregnant and currently uses a contraceptive coil. At night, she takes 5 mg of diazepam.
During examination, her BMI was found to be 24. She has coarse, dark hair on her chin, lower back, and inner thighs. There are no other clinical features to suggest Cushing’s, and she does not have galactorrhoea.
What is the most appropriate next step in investigating this patient’s condition?
MRCP2-1377
A 65-year-old male was prescribed thyroxine 150 micrograms daily for hypothyroidism. He was clinically hypothyroid and no goitre was present.
At a follow-up clinic, the following results were obtained: – Serum total T4: 68 nmol/L (55-145) – Serum total T3: 0.5 nmol/L (0.9-2.5) – Serum TSH: 70 mU/L (0.4-5)
What would be the next step in his management?
MRCP2-1378
A 55-year-old woman with a history of Grave’s disease is seen on the medical floor 24 hours after parathyroidectomy. She is experiencing episodes of carpopedal spasm and tingling sensations around her mouth and hands. Upon examination, her blood pressure is 120/80 mmHg, and her pulse is 90 beats per minute. Her serum calcium level is measured at 1.9 mmol/l.
What is the most suitable course of action?
MRCP2-1379
You assess a 63-year-old patient with type 2 diabetes who is currently on metformin 2 g per day, gliclazide 160 mg per day, and ramipril for renoprotection. The patient’s recent HbA1c was 68.31 mmol/mol (8.4%) and blood pressure was 140/75 mmHg. Upon reviewing the patient’s eye photograph, you observe dot-and-blot haemorrhages, cotton wool spots, and micro-aneurysms that are not in close proximity to the macula. What is the most effective treatment option to decrease the likelihood of further deterioration of the patient’s diabetic retinopathy in the long term, given these findings?
MRCP2-1380
A 62-year-old male presents to his doctor for a routine check-up and expresses concern about his overall health. He was diagnosed with hypertension two years ago and has since been on a diet to manage it. He quit smoking a decade ago but still drinks about 20 units of alcohol per week. He is worried about his weight and his family history of diabetes, as his father and mother both had it and suffered from stroke and heart attack respectively.
During the examination, his BMI is found to be 33.4 kg/m2, pulse is 82 beats per minute, and blood pressure is 148/92 mmHg. However, his cardiovascular, respiratory, and abdominal exams are normal except for central adiposity. His test results show normal full blood count, serum sodium, serum potassium, serum urea, and fasting plasma glucose. However, his alkaline phosphatase and serum triglycerides are high, while his aspartate transaminase and serum cholesterol are within normal range.
Given his family history and risk factors, what is the best approach to reduce the likelihood of this patient developing diabetes mellitus in the future?
MRCP2-1365
A 32-year-old male presents with hypertension, anxiety attacks, and palpitations. Upon screening for secondary hypertension, he consistently shows high urinary catecholamine concentrations. He is a part-time smoker, smoking 10 cigarettes per week, and drinks approximately 18 units of alcohol weekly. He has no significant medical history and is adopted, so no family history is available. He is referred to the local endocrine department where a CT scan of his abdomen reveals bilateral adrenal masses of 4 cm diameter. Additionally, an elevated plasma calcitonin concentration is noted. What other abnormality is likely to be present in this patient?
MRCP2-1366
A 27-year-old male presents with hypertension, agitation, and sweats that have been ongoing for six months. He has no significant family history, smoked 10 cigarettes per day, and drinks minimally. His current medications for hypertension include bendroflumethiazide 2.5 mg/d and ramipril 10 mg per day. On examination, his blood pressure is 176/94 mmHg, and his BMI is 23.5 kg/m2. Further investigations reveal a urine free metadrenaline level of 12 µmol/24 hr (<5) and a fasting plasma calcitonin level of 100 ng/L (0-11.5). An MRI scan of the abdomen shows a 3.5 cm mass in the right adrenal gland. What other diagnosis is likely to be associated with his condition?
MRCP2-1351
A 55-year-old woman is seen in your follow-up endocrinology clinic. She was referred by her GP a year ago after discovering a nodule in the front of her neck. Prior to this, she had experienced 6 months of worsening diarrhea and occasional flushing. She was diagnosed with a RET proto-oncogene mutation and underwent a thyroidectomy, followed by external beam radiotherapy. She is currently taking levothyroxine as her only medication.
What is the most effective test for monitoring the recurrence of this woman’s disease?
MRCP2-1367
An 80-year-old woman is admitted to the emergency department with hypothermia, sinus bradycardia, and unresponsiveness. A CT scan of the head shows no acute Intracranial issues. The patient is given passive warming and intravenous fluids. Blood tests are conducted, revealing the following results. Family members report that the patient has been experiencing symptoms of lethargy, cold intolerance, and weight gain over the past few months.
TSH >30.0 mU/L T3 <0.05 mU/L
What is the most appropriate initial treatment for this patient?