MRCP Part 2 Category: Endocrinology, Diabetes And Metabolic Medicine

MRCP2-1250

A 58-year-old male presents with impotence. He was diagnosed with diabetes mellitus 8 years ago and has been taking metformin for the last 2 years. He has noticed a decline in his erectile function over the last year and is now completely impotent. He is a non-smoker and drinks approximately 8 units of alcohol per week.

On examination, he is obese with a blood pressure of 150/90 mmHg. Testicular examination reveals normal testes of approximately 18 ml in volume. There are no abnormalities on cardiovascular, respiratory or abdominal examinations.

Investigations reveal:
– Haemoglobin: 140 g/L (130-180)
– White cell count: 8.5 ×109/L (4-11)
– Platelets: 190 ×109/L (150-400)
– Serum sodium: 143 mmol/L (137-144)
– Serum potassium: 4.2 mmol/L (3.5-4.9)
– Serum urea: 6.8 mmol/L (2.5-7.5)
– Serum creatinine: 105 µmol/L (60-110)
– Serum alkaline phosphatase: 90 U/L (45-105)
– Serum aspartate aminotransferase: 28 U/L (1-31)
– Serum gamma GT: 40 U/L (<50)
– HbA1c: 7.5% (3.8-6.4)
– Fasting plasma glucose: 8.0 mmol/L (3.0-6.0)
– Plasma testosterone: 6.8 nmol/L (9-33)
– Plasma FSH: 3.9 mU/L (3-12)
– Plasma luteinising hormone: 4.9 mU/L (3-10)

What further investigation would you recommend for this patient?

MRCP2-1235

A woman in her early 50s is undergoing treatment for symptomatic hypercalcemia related to squamous cell lung cancer (serum calcium 3.60 mmol/L). Despite initial measures of saline hydration and intravenous pamidronate, she is slow to respond. As she awaits surgical resection for her underlying cancer, what would be the most appropriate next step in her management?

MRCP2-1236

A 70-year-old man is recovering on the neurosurgical unit following a subdural haemorrhage. Five days earlier he underwent Burr hole surgery. You are consulted due to a persistently low sodium for the past two days. The following investigations were noted:

Day 3 post-surgery
Serum Na+ 118 mmol/l

Day 4 post-surgery
Serum Na+ 117 mmol/l
Urinary Na+ 30 mmol/l
Serum osmolality 282 mmol/l

Upon examination, the patient has dry mucous membranes and delayed capillary refill time.

What is the most likely diagnosis?

MRCP2-1221

A 28-year-old female presented to the general medicine outpatient clinic after being referred by her GP due to feeling generally tired for the past few months. Her blood screen revealed no abnormalities except for a potassium level of 2.8 mmol/l. A repeat test four weeks later showed a level of 2.6 mmol/l, leading to the referral. She denied any other symptoms and had no past medical history or family history of note. Examination revealed a well 28-year-old lady with normal vital signs and unremarkable findings on cardiovascular, respiratory, gastrointestinal, and neurological systems. Further investigations revealed low potassium levels and high serum renin and aldosterone levels. What is the most likely diagnosis?

MRCP2-1222

A 65-year-old woman visits the diabetes clinic after experiencing a left Colles fracture. The healthcare provider suspects that she may have underlying osteoporosis. The patient is currently taking metformin, pioglitazone, BD mixed insulin, ramipril, indapamide, and amlodipine. During the examination, her blood pressure is 145/72 mmHg, pulse is 78 and regular, and BMI is 32. The following investigations were conducted: Hb 129 g/L (115-160), WCC 6.2 ×109/L (4-11), PLT 188 ×109/L (150-400), Na 137 mmol/L (135-146), K 4.9 mmol/L (3.5-5.0), Cr 123 µmol/L (79-118), and Ca 2.56 mmol/L (2.20-2.61). Which medication is most likely linked to the risk of osteoporotic fracture in this patient?

MRCP2-1223

A 28-year-old man with a 20-year history of type 1 diabetes and poor glycaemic control recently visited the clinic for a review. He is overweight, has abnormal LDL cholesterol, and is interested in trying liraglutide as an adjunct to his insulin therapy. During the examination, his BP was 155/92 mmHg, pulse was 72/min and regular, and his BMI was elevated at 32. A recent HbA1c test showed a reading of 66.1 mmol/mol (35 – 55 mmol/mol).

What benefits can the man expect from adding liraglutide to his current treatment plan?

MRCP2-1224

An 80-year-old man is referred to the diabetic clinic by his GP due to newly discovered hyperglycaemia. He reported a two-month history of polyuria, polydipsia, and diarrhoea, and his blood sugar was found to be 18.4 mmol/L. During this time, he lost 6kg and now weighs 61 kg. The patient has a medical history of hypertension and was diagnosed with deep vein thrombosis three months ago. He is currently taking amlodipine 10 mg and warfarin. What is the diagnosis?

MRCP2-1225

A 47-year-old man presents with feeling unwell. Upon further inquiry, he reports feeling fatigued and weak for the past few weeks. His wife has noticed that he has lost some weight, although he claims that his appetite has not decreased. He also mentions feeling more thirsty and having to use the restroom several times during the night. Recently, he has developed a rash around his groin area, which has now spread to his buttocks. Upon examination, there are patches of red with irregular borders and crusting.

A fasting blood test is conducted, revealing a blood glucose level of 9.2 mm/l. What is the next most appropriate investigation?

MRCP2-1226

A 65-year-old male presents with a 6 month history of nocturia. He is diagnosed with type 2 diabetes mellitus based on a fasting plasma glucose concentration of 10.1 mmol/L. His HbA1c is 58 mmol/mol (7.5%) and he has a BMI of 35.2 kg/m2.
What is the probable Beta cell mass in this patient?

MRCP2-1227

A 30-year-old woman presents to the endocrinology clinic with a complaint of unintentional weight loss of 5kg. She denies any changes in her diet or exercise routine but reports feeling warmer, having trouble sleeping, and experiencing a slight tremor in her hands. Her medical history is significant for depression, which is managed with sertraline. Physical examination reveals a BMI of 24 kg/m², a resting tremor, and a large non-tender goiter without palpable nodules or lymphadenopathy. Laboratory tests show an undetectable TSH and a free T4 level of 39 pmol/l, confirming a diagnosis of hyperthyroidism. What is the most appropriate next step in determining the type of hyperthyroidism in this patient?