MRCP Part 2 Category: Endocrinology, Diabetes And Metabolic Medicine

MRCP2-1301

You assess a 54-year-old man who reports having undergone pituitary surgery (and ‘some treatment’ after the operation), some time ago. He presents with complaints of feeling lethargic, having reduced energy and vitality.

Upon examination, you note increased central abdominal adiposity and reduced grip strength. The patient is currently on thyroid and cortisol replacement therapy, and blood tests indicate that these are at adequate levels. FBC, U&E, and LFTs are all within normal limits.

What would be the most appropriate investigation to conduct next?

MRCP2-1302

A 30-year-old woman visits the clinic with concerns about her menstrual cycle. She reports heavy bleeding and cramping during her periods, which occur every 2-3 weeks. On examination, her BMI is 27 kg/m2. Her BP is slightly elevated at 140/90 mmHg and her pulse is 85/min and regular. You notice excess hair growth on her chin and upper lip, as well as on her chest and lower abdomen. There are no signs of abdominal distension or tenderness. The examination of external genitalia is normal.
Upon further questioning, she reports difficulty getting pregnant despite trying for over a year.
Which of the following would be an appropriate initial investigation?

MRCP2-1303

A 28-year-old woman presents to her primary care physician with concerns about excessive hair growth and acne. She reports irregular periods and occasional use of oral contraceptives.
During the physical exam, her BMI is 30 and her blood pressure is slightly elevated at 140/88 mmHg. She has mild hair thinning on the front of her scalp, increased hair growth on her upper lip and chin, and hair growth around her nipples and lower abdomen.
Further testing reveals an increased LH/FSH ratio and a testosterone level of 4.5 nmol/l (normal range: 1-2.5 nmol/l). Which of the following tests is most likely to confirm the diagnosis in this case?

MRCP2-1304

A 65-year-old woman with a history of hypertension and occasional episodes of palpitations is seen in the clinic with unintentional weight loss and hand tremors. She is found to be clinically hyperthyroid. She takes lisinopril and metoprolol.
The following results are obtained from her investigations:

Thyroxine (T4) 110 pmol/l 11–22 pmol/l
Thyroid-stimulating hormone (TSH) < 0.01 µU/l 0.17–3.2 µU/l
A thyroid ultrasound with color flow Doppler reveals increased blood flow.
What would be the recommended next step in management?

MRCP2-1305

A 54-year-old woman presents with a history of weight gain and nocturia for the past six months. She has also developed a vulvar candidal infection recently. Her mother had diabetes and died of a stroke at the age of 76. On examination, her BMI is 35.2 kg/m2 and blood pressure is 130/82 mmHg. Dipstick urine reveals ++ glucose. Diabetes is confirmed with a fasting plasma glucose of 10.2 mmol/l and HbA1c of 66 mmol/mol (8.2%). What is the likely underlying pathological entity causing her diabetes?

MRCP2-1306

A 20-year-old woman with a history of type 1 diabetes presents to the Emergency department with symptoms of nausea and vomiting. She has a coeliac disease and follows a gluten-free diet. Her usual HbA1c is 53 mmol/mol. On examination, she appears dehydrated and tanned, which she attributes to spending time in the garden after her exams. Her blood pressure is 100/80 mmHg with a postural drop of 20 mmHg, and her pulse is 88 beats per minute and regular. Laboratory investigations reveal abnormal levels of Hb, Na+, K+, urea, creatinine, CRP, and eosin.

What is the most crucial intervention for managing this patient?

MRCP2-1307

A 67-year-old Muslim man with type II diabetes is currently taking metformin (500mg three times a day) and is planning to fast during Ramadan. He will have a light meal before sunrise (Suhoor) and a large meal at sunset (Iftar). As his endocrinologist, what advice would you give him regarding his metformin intake before the sunset meal?

MRCP2-1308

A 48-year-old woman with a history of paroxysmal atrial fibrillation undergoes a thyroidectomy for Graves’ disease. After several months, her symptoms recur, including palpitations from atrial fibrillation, and residual thyroid tissue is noted on postoperative scans. She is now scheduled for radioiodine therapy, but is admitted three days before the procedure with acute-onset abdominal pain. Although ischaemic colitis is suspected, an urgent CT scan of the abdomen with contrast rules out any acute pathology and she is discharged. What is the earliest possible time for her to receive the radioiodine therapy?

MRCP2-1309

A 16-year-old male is being seen at the endocrinology clinic for presenting with low serum testosterone and a lack of secondary sex characteristics. He has never fully developed pubertal body hair or muscle mass, and has small testicles. Additionally, he was born with a cleft palate and has difficulty with his sense of smell. What is the probable underlying diagnosis?

MRCP2-1310

A 18-year-old boy attends the clinic. He is concerned as she has not yet started puberty. He would like to be able to form relationships with girls but feels like he can’t at the moment. On examination, he is of average height and has absent secondary sexual hair, a small penis and testes. On further questioning, he reports occasional headaches and blurred vision.
Investigations

Haemoglobin 130 g/l 120–160 g/l
White cell count (WCC) 7.0 × 109/l 4–11 × 109/l
Platelets 250 × 109/l 150–400 × 109/l
Sodium (Na+) 142 mmol/l 135–145 mmol/l
Potassium (K+) 4.2 mmol/l 3.5–5.0 mmol/l
Creatinine 60 µmol/l 50–120 µmol/l
Follicle-stimulating hormone (FSH) High
Luteinizing hormone (LH) High
Given the likely diagnosis, what appearance would you expect to see on pituitary magnetic resonance imaging (MRI)?