MRCP Part 2 Category: Endocrinology, Diabetes And Metabolic Medicine

MRCP2-1242

A 37-year-old woman presents at 16 weeks gestation with a severe headache affecting the left side of her forehead and blurred vision in her left eye that occurred while on vacation in Spain. The symptoms resolved within 12 hours with paracetamol. She has a history of microprolactinoma, which was treated with cabergoline for three years and successfully stopped two years ago. She has no other significant medical history except for migraines for the past 15 years. On examination, her pulse is 78 beats per minute, blood pressure is 118/66 mmHg, and there is no galactorrhoea. Visual acuity, pupillary reflexes, and fields of vision are normal, as is the rest of the systemic examination. Investigations reveal elevated plasma prolactin levels and thyroid function tests within the normal range. What is the most appropriate management plan?

MRCP2-1243

A 42-year-old man presents with complaints of decreased sexual desire and difficulty achieving orgasm. He reports feeling stressed at work and having trouble balancing his responsibilities at home. Blood tests from his primary care physician show normal thyroid function, but elevated prolactin levels at 2800 mU/l (< 360) and low testosterone levels. He admits to drinking two glasses of wine per night. There are no reported visual disturbances.
What is the most probable cause of his impotence?

MRCP2-1244

A 56-year-old man is being seen in clinic due to resistant hypertension despite being treated with ramipril, amlodipine, indapamide, and bisoprolol. He appears comfortable at rest.

Observations:

– Temperature: 36.5ºC
– Blood pressure: 182/125 mmHg
– Heart rate: 88/min
– Respiratory rate: 16/min
– Saturations: 97% on air

Investigations:

– Na+: 148 mmol/l
– K+: 2.9 mmol/l
– Urea: 6.5 mmol/l
– Creatinine: 92 µmol/l
– Renin: Low
– Aldosterone (supine): High
– Aldosterone (prolonged standing): Increase from supine levels

Blood gases:

– PaO2: 11.2kPa
– PaCO2: 5.2kPa
– pH: 7.49
– HC03-: 32 mmol/l
– BE: +4

What is the most likely diagnosis for this patient?

MRCP2-1245

A 50-year-old man presents to the Emergency Department after experiencing a fainting episode. He reports feeling fatigued and nauseous. The patient has a medical history of type 2 diabetes mellitus and HIV infection, but admits to being non-compliant with his medications, including anti-retroviral therapy.

Upon examination, the patient’s pulse is regular at 65 beats per minute, blood pressure is 90/62 mmHg, and respiratory rate is 26 breaths per minute.

The following investigations were conducted:
– Haemoglobin: 14.0 g/dL (13.0-18.0)
– White cell count: 4 x 10^9/L (4-11)
– Platelets: 150 x 10^9/L (150-400)
– Sodium: 130 mmol/L (135-145)
– Potassium: 5.8 mmol/L (3.5-5.0)
– Creatinine: 80µmol/L (60-110)
– Glucose: 4.0 mmol/L (4.0-7.8)

What is the most appropriate next step in management?

MRCP2-1246

You are requested to evaluate a 43-year-old alcoholic who has been admitted to the medical ward after experiencing 72 hours of vomiting, generalized muscle weakness, and palpitations. Despite receiving two calcium infusions, the latest calcium measurement is still 1.89 mmol/l. During the examination, his blood pressure is 95/60 mmHg, and his pulse is regular at 95 beats per minute. You observe intermittent runs of SVT on his cardiac monitor.

The following are the other urea and electrolyte levels:

Na+ 132 mmol/l
K+ 3.7 mmol/l
Urea 5.4 mmol/l
Creatinine 82 µmol/l
Glucose 5.2 mmol/l

What is the most appropriate next step?

MRCP2-1247

A 50-year-old woman with chronic alcohol abuse admitted 4 days ago for nausea and severe diarrhoea now presents with peri-oral and finger tingling. She was admitted for hydration after 1 week of severe watery diarrhoea. Despite receiving intravenous hydration and dextrose, she has been unable to tolerate oral nutrition due to persistent nausea. Her vital signs are stable with a blood pressure of 130/74 mmHg, pulse of 68/min, and respiratory rate of 16/min. She has no fever.

During physical examination, the patient exhibits facial twitching upon percussion of her facial nerve just anterior to the ear. Additionally, carpal spasm is induced after the inflation of a blood pressure cuff on her arm.

What is the most likely cause of these findings?

MRCP2-1248

You are requested to assess a 68-year-old male who is currently admitted to a surgical ward with new onset paraesthesia in his fingers. He underwent an elective parathyroidectomy three days ago for long-standing hyperparathyroidism and subsequent hypercalcaemia. The surgery involved the removal of a single parathyroid adenoma which was identified on pre-operative MIBI scanning. Although the procedure was uneventful, he is now experiencing a tingling sensation in his fingers which he first noticed about twelve hours ago. Additionally, he complains of severe pain in both ankles which worsens with walking and is also present at rest. The surgical SHO has already arranged for ankle x-rays which reveal multiple osteolytic lesions that are suspicious for metastatic disease. Apart from regular prophylactic dalteparin, paracetamol, and tramadol, he is otherwise healthy. The following are his blood test results:

Adjusted Calcium 1.84 mmol/L
Magnesium 0.7 mmol/L

What is the most probable cause of his current symptoms?

MRCP2-1233

A 47-year-old woman comes to the Medical Outpatient Clinic seeking advice. She has been taking atenolol for hypertension for the past two years. During her visit, she asks about hormone replacement therapy (HRT) as she suspects she may be going through menopause due to hot flashes, mood swings, and missed periods for the past six months. She has no history of thromboembolism, stroke, or breast cancer, but is concerned about the conflicting information she has read in the media regarding the risks of HRT, particularly in relation to deep venous thrombosis (DVT) and heart disease. What is the correct statement regarding combined oestrogen-progestin therapy for HRT?

MRCP2-1249

A 67-year-old Indian patient presents to the emergency department with facial tetany, muscle cramps and paraesthesia of her fingers and toes. This is her third admission with similar symptoms. Her past medical history includes diffuse cutaneous systemic sclerosis with gastrointestinal, cutaneous and pulmonary manifestations. She was also diagnosed with vitamin D deficiency three years ago and receives regular vitamin D supplements.

Her blood tests are as follows:

Hb 124 g/l
WBC 8.0 * 109/l
Na+ 141 mmol/l
K+ 4.3 mmol/l
Urea 6.5 mmol/l
Creatinine 90 µmol/l
CRP 15 mg/l
Corrected calcium 1.68 mmol/l
Phosphate 1.4 mmol/l
Magnesium 0.28 mmol/l
PTH 2 pmol/L (normal range = 8.5-12)
Amylase 14 u/l

Her symptoms improve with intravenous calcium replacement and intravenous magnesium replacement, correcting both electrolytes to within normal range. What is the underlying cause for these metabolic disturbances in this patient?

MRCP2-1234

A 49-year-old woman presents to your clinic with concerns about osteoporosis. She underwent a hysterectomy and oophorectomy due to uterine fibroids a year ago and has been experiencing persistent and troublesome hot flushes since then. Her mother recently suffered a femoral neck fracture, which has increased the patient’s anxiety about her own risk of fractures in the future. She has no other significant medical history, is a non-smoker, drinks five units of alcohol per week, and maintains a healthy diet. On examination, she appears fit and thin with a BMI of 18 kg/m2, has a blood pressure of 122/88 mmHg, and normal breast examination. What recommendations would you make for her?