MRCP Part 2 Category: Endocrinology, Diabetes And Metabolic Medicine

MRCP2-1229

A 35-year-old woman has been referred to you for management of her obesity.

When considering treatment options for this patient, it is important to take into account her medical history, current lifestyle habits, and any underlying conditions that may be contributing to her weight gain. A comprehensive approach to weight loss may include dietary modifications, increased physical activity, behavioral therapy, and possibly medication or surgery. It is important to work with the patient to develop a personalized plan that is sustainable and achievable for her individual needs and goals. Regular follow-up and support can also be crucial for long-term success in managing obesity.

MRCP2-1230

A 65-year-old female who is a retired teacher presents to the Emergency department with sudden difficulty breathing after a long flight. She has not experienced any other health issues recently.
During the examination, her pulse is found to be 98 bpm, her oxygen saturation is 92% on air, and her blood pressure is 120/80 mmHg. Her legs and chest appear normal.
The medical team suspects a pulmonary embolism and starts her on IV heparin therapy. A VQ scan confirms the diagnosis.
Despite not showing any signs of thyrotoxicosis, the doctors perform thyroid function tests due to her previous occupation. The results show:
TSH 1.5 mU/L (0.35-5.0)
free T4 44.2 pmol/L (9.8-21.2)
free T3 6.5 pmol/L (3.5-6.8)
What is the probable cause of the abnormal thyroid function tests in this patient?

MRCP2-1215

A 50-year-old man visits his GP for a routine check-up of his type 2 diabetes, which he manages with metformin. He recently had an NSTEMI and is now taking aspirin, clopidogrel, bisoprolol, and ramipril.

Blood tests taken 6 months ago showed:

– HbA1c of 51 mmol/mol (<48) Today’s blood tests show: – HbA1c of 47 mmol/mol (<48) What is the appropriate course of action for managing this patient’s type 2 diabetes at this stage?

MRCP2-1231

A 55-year-old male patient undergoes blood tests and the results are as follows:

LH: 1 U/L (normal range: 1.3-8.4)
FSH: <1 U/L (normal range: 2.9-8.4)
Testosterone: 7.5 nmol/L (normal range: 10-28)

What is the probable diagnosis?

MRCP2-1216

A 49-year-old man comes for a diabetes check-up after being prescribed metformin 500mg TDS. His latest HbA1c reading is 48 mmol/mol and he has not experienced any hypoglycaemic episodes.

The patient has a medical history of atrial fibrillation and heart failure with preserved ejection fraction. He is currently taking apixaban, bisoprolol, atorvastatin, and ramipril.

What would be the most suitable course of action for managing his diabetes?

MRCP2-1232

A 45-year-old woman presents with a one-year history of tiredness, weight gain, and fatigue. She had undergone trans-sphenoidal resection of a non-functioning pituitary tumor two years ago, which resulted in pan-hypopituitarism. Currently, she is being treated with hydrocortisone, thyroxine, and oral contraceptive Logynon. On examination, her blood pressure is 110/64 mmHg, and her pulse is 80 bpm. Her free T4 level is 12.5 pmol/L, plasma TSH is 0.2 mU/L, and serum estradiol is <80 pmol/L. What is the most appropriate treatment for her fatigue?

MRCP2-1217

A 62-year-old man presents with recent blood test results. He has a medical history of hypertrophic cardiomyopathy, fibromyalgia, and haemorrhoids. He takes bisoprolol and disopyramide for his cardiomyopathy and is part of a graded exercise programme for his fibromyalgia. His blood results show an HbA1c of 49 mmol/mol (<42) and a fasting plasma glucose of 6.9mmol/L (3.9-5.4). Although he denies symptoms of polydipsia or polyuria, he reports feeling more fatigued than usual. What would be the most appropriate initial treatment regimen for him based on his blood results?

MRCP2-1218

A 32-year-old woman comes in for her first prenatal visit at 12 weeks gestation. She has a medical history of Hashimoto’s thyroiditis and is currently taking levothyroxine 100 mcg. Her recent blood work shows a TSH level of 1.0 mU/l.

What is the recommended course of action for managing her levothyroxine treatment now that she is pregnant?

MRCP2-1219

A 45-year-old man presents to his GP with a lump on the right side of his neck that has been present for 4 weeks. The lump measures approximately 7 mm and is located on the right side of the thyroid gland in the anterior triangle. The patient reports that the lump does not move when he sticks out his tongue, but it does move on swallowing. He denies any weight loss or night sweats.

Laboratory tests are ordered and reveal:

– Hemoglobin: 12.9 g/l
– Platelets: 210 * 109/l
– White blood cells: 6.0 * 109/l
– Sodium: 141 mmol/l
– Potassium: 3.9 mmol/l
– Urea: 4.1 mmol/l
– Creatinine: 33 µmol/l

What is the most appropriate initial investigation for this patient?