MRCP Part 2 Category: Endocrinology, Diabetes And Metabolic Medicine

MRCP2-1360

A 17-year-old woman presents to her primary care physician with recurrent episodes of vaginal thrush. She has no other significant symptoms indicating hyperglycemia. A strong family history of type 2 diabetes is noted and the physician arranges to check fasting plasma glucose. Two samples are checked and the laboratory glucose results are 8.1 and 8.2 mmol/l. Urine is negative for ketones. HbA1C, also checked by the physician, is elevated at 74 mmol.mol (8.9%). Her BMI is 23 and her BP is 110/75.
What is the most appropriate initial treatment for this patient?

MRCP2-1361

You are assessing an elderly gentleman with type 2 diabetes. He is currently taking metformin and a once daily long-acting insulin analogue at night. He regularly monitors his blood sugar levels in the morning and has recently contacted the clinic due to experiencing some low readings. In the past 1-2 weeks, he has had three readings between 3.0 and 4.0 mmol/L. He is currently on a nightly dose of 40 units of insulin. What is the most appropriate advice to give regarding his insulin dosage?

MRCP2-1362

A 30-year-old woman with a past medical history of infertility and severe reflux symptoms came to the clinic with a high calcium level of 2.80 mmol/l. Upon testing, her PTH levels were found to be elevated. What is the diagnosis?

MRCP2-1363

A 25-year-old female patient visits the clinic with asymptomatic hypercalcemia. She reports experiencing intermittent indigestion and a loss of libido, but no other notable symptoms. During the examination, her blood pressure is 124/72 mmHg, pulse is 78 and regular, and her BMI is 22. Respiratory and abdominal examinations reveal no abnormalities. The following are the results of her investigations:

– Haemoglobin: 120 g/L (11.5-16.0)
– White cell count: 7.0 ×109/L (4-11)
– Platelets: 228 ×109/L (150-400)
– Sodium: 138 mmol/L (135-146)
– Potassium: 3.9 mmol/L (3.5-5)
– Creatinine: 113 µmol/L (79-118)
– Calcium: 2.94 mmol/L (2.21-2.60)
– Prolactin: 1350 mU/L (<520) Which type of pancreatic tumor is most likely to be present in this patient?

MRCP2-1364

A 28-year-old female patient presents with symptoms of headaches, sweating, anxiety, and palpitations. She reports a family history of similar symptoms on her father’s side, which required surgery. Additionally, she complains of constipation and polydipsia. During examination, her blood pressure is elevated at 160/95. Two 24-hour urinary collections for catecholamines were above the upper limit of normal, and her bone profile shows elevated corrected calcium and parathyroid hormone levels. The physician recommends genetic testing to diagnose which condition?

MRCP2-1333

A 20-year-old female presents with recurrent episodes of cystitis despite treatment with trimethoprim. She has a history of diabetes mellitus since the age of 12 and is currently on twice daily mixed insulin. Additionally, she has been taking oral contraceptives for the past two years and smokes 10 cigarettes per day. Her two elder brothers are healthy. On examination, she appears thin but well with a BMI of 21.5 kg/m2, a blood pressure of 108/76 mmHg, and normal cardiovascular, respiratory, and abdominal findings.

Laboratory investigations reveal serum sodium of 140 mmol/L (137-144), serum potassium of 4.5 mmol/L (3.5-4.9), serum urea of 5.6 mmol/L (2.5-7.5), serum creatinine of 95 µmol/L (60-110), fasting plasma glucose of 10.2 mmol/L (3.0-6.0), and HbA1c of 87 mmol/mol (20-42) or 10.1% (3.8-6.4). An ultrasound of the abdomen suggests reflux nephropathy.

What is the optimal treatment plan to preserve her renal function?

MRCP2-1349

A 72-year-old man has routine blood tests that were requested by his primary care physician (PCP). He is incidentally found to have an elevated calcium level of 3.05 mmol/l. During discussion with his PCP, he reports experiencing constipation for the past 6 months and feeling more fatigued. He has had a poor appetite and sometimes feels nauseous. He also has abdominal distension, has not had a bowel movement in 5 days, and cannot recall passing gas in the last 24 hours. An abdominal x-ray is arranged via the surgical assessment unit, and his parathyroid hormone level is found to be high (7.5 pmol), which confirms primary hyperparathyroidism. What is the most probable cause of this patient’s primary hyperparathyroidism?

MRCP2-1334

A 28-year-old female with a history of successfully treated thyrotoxicosis experienced a relapse in the third trimester of her pregnancy. She was briefly treated with carbimazole but had to discontinue due to intolerance. Now four weeks postpartum, she continues to experience symptoms such as tremors, sweats, palpitations, weight loss, and flushing. She wishes to breastfeed her healthy infant boy. On examination, she has a fine tremor, a pulse rate of 110/min-1, and lid lag. She also has a palpable goitre with an audible bruit and exhibits exophthalmos, chemosis, and lid-lag upon eye examination. Her lab results show a low TSH level and high free T4 and T3 levels. What is the most appropriate treatment for her thyrotoxicosis?

MRCP2-1350

A 36-year-old man presents to the endocrine clinic following his second episode of acute pancreatitis. During his follow-up appointment with the surgical registrar, it was noted that his fasting triglycerides were 8.2 mmol/l (0.7-2.1), despite his LDL level not being particularly raised. On examination, his blood pressure is 125/70 mmHg, his pulse is 70 and regular, and he has a BMI of 23. Additionally, there is evidence of eruptive xanthomas on his skin. What is the most appropriate therapy for him?

MRCP2-1335

A 32-year-old female is referred by her GP, being 10 weeks pregnant.

Three months ago, she was diagnosed with thyrotoxicosis with an elevated T4 concentration and suppressed TSH concentration. Her GP started her on carbimazole at that time.

During her presentation, she has a pulse of 90 beats per minute, a fine tremor, and lid lag. Her blood pressure is 118/80 mmHg, and she has a palpable goitre.

What is the most appropriate treatment for this patient?