MRCP Part 2 Category: Endocrinology, Diabetes And Metabolic Medicine

MRCP2-1643

A 20-year-old woman presents to the endocrinology clinic with a history of feeling weak and needing a sweet drink to improve. This has been happening frequently since she was rejected from applications to medical school. She has a previous history of anxiety, but her parents have become concerned after using her sister’s glucose monitoring equipment (who has type 1 diabetes) and finding her capillary glucose as low as 2 mmol/l. They are worried that she may have an insulinoma after reading about it on the internet and have requested an endocrinology referral from the GP. What is the most appropriate investigation to rule out insulinoma?

MRCP2-1628

A 30 year old man presents to the endocrinology clinic. He is worried because his mother had a ‘brain tumour’ removed 2 years ago and has now been told she has another tumour in her abdomen after going to her doctor with reflux and indigestion. She has been told it might be a genetic problem and is awaiting testing. He is concerned he might also have the condition and so his GP has referred him to the clinic.

He is currently asymptomatic.

On examination there is no abnormality on the cardiovascular, respiratory, abdominal or neurological examinations.

The doctor explains that the most appropriate person to see would be the geneticist to whom his mother has been referred. He asks him to obtain the details if his mother is willing to provide them and says that he will refer him. In the meantime, he offers to carry out some screening blood tests.

Given the likely underlying diagnosis, which of the following is most likely to be abnormal?

MRCP2-1644

A 65-year-old man presents for a routine medical check-up at his GP clinic. He has a history of childhood asthma and osteoarthritis in his fingers but is otherwise healthy. During the check-up, his vital signs were recorded as a blood pressure of 129/80 mmHg, pulse rate of 82 bpm, and oxygen saturation of 97%. Blood tests were ordered and the results showed normal levels for most parameters, except for a slightly elevated γGT and serum corrected calcium. A 24-hour urinary calcium test was performed, which revealed a significantly low result. Based on these findings, what is the most likely diagnosis?

MRCP2-1629

A 35-year-old female patient complains of frequent palpitations that have worsened over the past week. Her blood pressure is 130/80 mmHg, and her ECG shows atrial fibrillation. During the examination, a palpable, smooth thyroid goitre is detected. She gave birth three months ago and is currently breastfeeding her healthy baby. She has no medical history. Her TSH is < 0.05 mU/l, and she is positive for TSH receptor and TPO antibodies. What is the most likely diagnosis for her goitre?

MRCP2-1630

A 32-year-old woman presents to the endocrinology clinic with symptoms of heat intolerance, tremors, and diarrhea. She was referred by her General Practitioner after blood tests showed evidence of thyrotoxicosis. The patient has been experiencing these symptoms for approximately 4 weeks and attributes them to the stress of caring for her 6-week-old baby. She denies any pain on eye movements, diplopia, or skin rashes.

On examination, a small, diffuse, and mildly tender goitre is noted with no evidence of thyroid bruit. Fine tremors are observed in her outstretched hands, but there is no exophthalmos or proptosis. The patient has no past medical history except for her recent pregnancy and delivery by vaginal delivery. She takes no regular medications and has no family history of thyroid disorders. Prior to her maternity leave, she worked as a lawyer and does not drink or smoke.

Investigations reveal a thyroid stimulating hormone of 0.1 microU/L (reference 0.4-5.0), T4 free serum of 19.5 pmol/L (reference 8.5-15.2), T3 free serum of 8.1 pmol/L (reference 3.5-6.5), thyroid peroxidase antibodies of 250 mU/L (reference <150), and an erythrocyte sedimentation rate of 21 ml/h. Thyroid scintiscanning (Technetium-99) shows no significant thyroid uptake. What is the most likely diagnosis?

MRCP2-1631

A 32-year-old woman who is 38-weeks pregnant presents to the hospital in labor. She has a firm, rigid abdomen and the fetal monitor shows signs of distress. Upon examination, she is diagnosed with placental abruption and undergoes an emergency cesarean section. Due to excessive bleeding of over 3 liters, the major hemorrhage protocol is initiated.
After being discharged from the hospital, she visits her primary care physician complaining of an inability to breastfeed and persistent fatigue. Her doctor suspects that she may be suffering from Sheehan syndrome.
Which specific anatomical structure has suffered from infarction, leading to the development of this syndrome?

MRCP2-1632

An 82-year-old woman presents to the Emergency Department with significant weight loss and dehydration. She reports experiencing steatorrhoea for a few months, and her family members confirm the gradual weight loss. During her hospital stay, she is diagnosed with a metastatic somatostatinoma. What is the most probable complication she may experience due to the somatostatinoma?

MRCP2-1633

A 65-year-old lifelong smoker presents to his GP with a four day history of wheezing and leg swelling. Despite being prescribed diuretics and other medications, his condition continues to worsen. His BP is 120/70 mmHg with a postural drop of 15 mmHg, and his pulse is 80 bpm and regular. Laboratory tests reveal the following results:
– Sodium (Na+): 132 mmol/l (normal range: 135-145 mmol/l)
– Potassium (K+): 4.8 mmol/l (normal range: 3.5-5.0 mmol/l)
– Urea: 30 mmol/l (normal range: 2.5-6.5 mmol/l)
– Creatinine (Cr): 190 μmol/l (normal range: 50-120 µmol/l)
– Bicarbonate (HCO3-): 17 mmol/l (normal range: 24-30 mmol/l)
Arterial blood gas analysis shows the following results:
– pH: 7.10 (normal range: 7.35-7.45)
– pCO2: 7.2 kPa (normal range: 4.6-6.0 kPa)
– pO2: 6.8 kPa (normal range: 10.5-13.5 kPa)
What is the most likely diagnosis based on these findings?

MRCP2-1634

A 25-year-old man visits his GP for a routine check-up. During the appointment, the GP notices that his glucose levels are slightly elevated. The man is referred to the Diabetic Clinic, where you conduct a thorough medical history.

The man has no previous medical conditions and is generally healthy. However, his father and grandfather both have diabetes, which was diagnosed at a young age. His father manages his diabetes through diet and exercise, while his grandfather requires insulin. The man’s family is health-conscious and maintains a BMI around 20 kg/m2.

Upon testing, the man’s fasting venous glucose is 10 mmol/l. What is the most likely diagnosis in this case?

MRCP2-1635

A 32-year-old man comes to the clinic complaining of recurrent palpitations. Despite being able to perform his job as a construction worker, he feels increasingly fatigued. He has no significant medical history and is not taking any medications.
During the examination, his blood pressure is 118/70 mmHg, with a pulse of 80/min and regular. His BMI is 27. His TSH level is 0.2 mU/l (0.4–5), free T4 is 19.5 pmol/l (10–22), and free T3 is 9.0 pmol/l (5–10).
What is the most likely diagnosis?