MRCP Part 2 Category: Endocrinology, Diabetes And Metabolic Medicine
MRCP2-1200
A 35-year-old female patient presents to her GP requesting a cholesterol check. She has a medical history of endometriosis and controlled type 2 diabetes through diet. She drinks a glass of red wine every evening and exercises regularly. She is currently taking oral contraceptives. The results of her tests are as follows: Test Result Normal Range LDL cholesterol 4.8 mmol/l < 3.5 mmol/l Triglycerides 1.9 mmol/l 0–1.5 mmol/l HDL cholesterol 0.7 mmol/l > 1.0 mmol/l What is the most likely reason for the patient’s low HDL cholesterol levels?
MRCP2-1189
A 58-year-old male presents with weight loss, weakness, and increasing confusion. He was diagnosed with small cell carcinoma of the lung eight months ago and has undergone chemotherapy.
On examination, he is disorientated in time and place, has evidence of weight loss, and a BMI of 22.6 kg/m2. His blood pressure is 160/98 mmHg with a pulse of 88 bpm. He has weakness of leg extension and has difficulty rising from a seated position. He also has shoulder weakness.
A 49-year-old woman visits her GP complaining of hot flushes and night sweats for the past few weeks. She also mentions difficulty concentrating and disturbed sleep at night. Her husband reports mood swings. On examination, her blood pressure is 122/78 mmHg, heart rate is 78 bpm, and BMI is 23 kg/m2. Abdominal examination is normal. She is prescribed hormone replacement therapy and asks about its benefits. What is associated with hormone replacement therapy?
MRCP2-1191
A 25-year-old woman presents with a history of weight gain and amenorrhoea for the past four months. Upon examination, she has a BMI of 33 and mild hirsutism. Her test results show a serum oestradiol level of 1200 pmol/L (130-800), serum testosterone level of 2.8 nmol/L (<3.0), serum prolactin level of 1500 mU/L (50-450), serum LH level of 1.2 U/L (1.2-8.0), and serum FSH level of 1.5 U/L (1.5-8.0). What is the most likely diagnosis?
MRCP2-1192
A 25-year-old female patient comes to the clinic complaining of amenorrhoea. Upon conducting blood tests, the following results were obtained:
Prolactin 320 IU/L (<230)
Oestrogen 900 pmol/L (100-400 follicular phase)
LH <1 IU/L -
FSH 2 IU/L –
Based on these findings, what is the most probable diagnosis?
MRCP2-1193
A 16-year-old girl presents to the clinic with complaints of agitation and weight gain. She is accompanied by her mother who reports that her daughter has been increasingly agitated with poor sleep over the last two months. Although her progress at school has been fine up until recently, she has become apathetic. The patient has no significant medical history. On examination, her blood pressure is 112/70 mmHg and her BMI is 20. The GP’s letter reveals the following results: TSH 3.2 mU/L (0.4-5.0), Total T4 250 nmol/L (55-144), Free T4 12.9 pmol/L (10-22), Total T3 3.2 nmol/L (0.9-2.8), Free T3 3.8 pmol/L (5-10). What is the likely diagnosis?
MRCP2-1178
A 38-year-old teacher is discovered collapsed outside her home. Upon arrival at the Emergency department, her blood glucose level is measured at 1.9 mmol/L. What immediate investigations should be conducted?
MRCP2-1194
A 54-year-old man with type 1 diabetes presents to the hospital with a day of vomiting and diarrhea. He experienced indigestion earlier in the day, which he treated with antacids, but the burning pain in his chest and throat persisted for four hours. Despite several insulin boluses, his blood glucose continued to rise. He denies any missed doses of insulin, changes in exercise, or skipped meals. He smokes 20 cigarettes a day and manages his diabetes with a basal bolus regimen and correction doses based on carbohydrate counting.
During the examination, the patient appears sweaty with dry mucosa. His heart rate is 125/min, respiratory rate is 28/min with prolonged expiration phases, blood pressure is 110/90 mmHg, and temperature is 37ºC. The nurse measures his blood glucose, which is 27 mmol/l, and his blood ketones, which are 4 mmol/l.
Lab results show Hb 130 g/l, Na+ 133 mmol/l, Platelets 356 * 109/l, K+ 4.5 mmol/l, WBC 9.8 * 109/l, Neuts 7.5 * 109/l, Lymphs 1.0 * 109/l, Eosin 0.1 * 109/l, Urea 6.2 mmol/l, Creatinine 98 µmol/l, CRP 34 mg/l, and HbA1c 48 mmol/mol (normal range <42). The ECG shows deep T-wave inversion in V1-V4, and the chest x-ray shows no acute abnormalities.
What is the most likely cause of this patient’s presentation?
MRCP2-1179
A 20-year-old man presents to the endocrinology clinic for follow-up. He was previously managed in the paediatric clinic for congenital hypoparathyroidism and is currently receiving vitamin D and calcium supplements. He has a history of one episode of renal stones in the past 2 years and his creatinine level is elevated at 125 micromol/l. What is the optimal target for his serum calcium level?
MRCP2-1180
You are evaluating a 55 year-old man in the diabetes clinic who has type 2 diabetes mellitus. He is presently on a regimen of metformin 850mg thrice daily and gliclazide 80mg once daily.
Upon further inquiry, he confesses to experiencing frequent hypoglycemic episodes at night that cause him distress as he lives alone. He has a BMI of 30.3 kg/m², HbA1c of 7.8% (62 mmol/mol), and co-morbidities that include congestive cardiac failure.
What modifications would you make to his diabetic therapy?