MRCP Part 2 Category: Endocrinology, Diabetes And Metabolic Medicine

MRCP2-1636

A 40 year-old woman presents to her GP with a 4 month history of increasing anxiety. On further questioning, she has lost 5 kg of weight over the past 3 months and has been experiencing increased bowel movements and diarrhoea.

Blood tests are performed and reveal:

Hb 13.8 g/dL
Platelets 200 * 109/l
WBC 7.2 * 109/l
Thyroid stimulating hormone (TSH) 0.05 mu/l
Free thyroxine (T4) 18.2 pmol/l
Total triiodothyronine (T3) 12.8 nmol/l Normal range (4.0-8.3 nmol/l)

What is the most appropriate treatment?

MRCP2-1621

A frail 83-year-old gentleman was brought in by his son, who found him on the floor in his apartment. He had tripped in a mechanical and had been unable to get back up, lying on the floor for the past 3 days. On examination, he appears extremely dehydrated but has no specific focal weakness, systemic examination is unremarkable. He has sustained no musculoskeletal injuries. His blood tests are as follows:

Na+ 168 mmol/l
K+ 6.0 mmol/l
Urea 24 mmol/l
Creatinine 260 µmol/l (baseline 107 three months ago)
Creatinine kinase 11,000 mmol/l

ECG shows normal sinus rhythm at 99/ minute.

You diagnose him with rhabdomyolysis and an acute kidney injury, likely of a pre-renal cause. Intravenous fluid rehydration is initiated with intravenous 5% dextrose. You ask your colleague to check the patient’s blood tests in 12 hours.

What is the reason for correcting the patient’s hypernatraemia?

MRCP2-1606

A 50-year-old female presents with symptoms of depression, constipation, polyuria, and thirst. She has been experiencing tiredness and arthralgia for the past six months since being diagnosed with hypertension and taking bendroflumethiazide 2.5 mg daily. Physical examination is normal except for a blood pressure of 162/94 mmHg. Her lab results show elevated serum sodium and corrected calcium levels, as well as high plasma parathyroid hormone levels. What is the most suitable initial treatment for this patient?

MRCP2-1622

A 35-year-old construction worker presents for review. He is 6 feet 2 inches tall and has signs of delayed puberty and infertility on examination, notably small testes with scanty pubic hair.
Investigations:
s
Follicle-stimulating hormone (FSH) 40 u/l 1 – 7 u/l
Testosterone 6 nmol/l 9 – 25 nmol/l
What is the most likely diagnosis based on this clinical presentation and laboratory results?

MRCP2-1607

A 35-year-old man presents to the clinic with complaints of heart palpitations. He reports experiencing occasional anxiety attacks and loose bowel movements for the past 2 weeks. He denies any recent illnesses or changes in weight. On examination, his thyroid is tender but not enlarged. His pulse rate is 100/min and regular.
Thyroid function tests:
Thyroid-stimulating hormone (TSH) 0.2 mu/l 0.4 – 5.0 mu/l
Thyroxine (T4) 200 nmol/l 58 – 178 nmol/l
Triiodothyronine (T3) 3.5 nmol/l 1.07 – 3.18 nmol/l
Erythrocyte sedimentation rate (ESR) 40 mm/h 1 – 20 mm/h
What is the most appropriate next step in management?

MRCP2-1623

A 38-year-old woman presents to the emergency department with a suspected drug overdose and reduced GCS. She has a history of type 2 diabetes and takes gliclazide. Upon examination, she appears pale and sweaty. During her initial assessment, the following result is obtained:

Blood glucose 2.0 mmol/L (>3.9 mmol/L)

After receiving an infusion of 50% dextrose, her glucose level is rechecked:

Blood glucose 2.5 mmol/L (>3.9 mmol/L)

What other treatment options should be considered to stop the underlying process?

MRCP2-1608

A 35-year-old woman who is 34 weeks’ pregnant comes to the Obstetrics Clinic for review. She has found it increasingly difficult to maintain her weight during the past few weeks, and has been suffering from palpitations and anxiety. She has no past medical history of note.

Examination reveals a BP of 120/70 mmHg, with pulse 90/min and regular. She has a fine resting tremor and a smooth, non-tender goitre.

Investigations:
Haemoglobin (Hb) 130 g/l 135 – 175 g/l
White cell count (WCC) 6.5 × 109/l 4.0 – 11.0 × 109/l
Platelets (PLT) 200 × 109/l 150 – 400 × 109/l
Sodium (Na+) 138 mmol/l 135 – 145 mmol/l
Potassium (K+) 4.2 mmol/l 3.5 – 5.0 mmol/l
Creatinine (Cr) 80 µmol/l 50 – 120 µmol/l
Glucose 5.0 mmol/l 3.9 – 7.1 mmol/l
Thyroid-stimulating hormone (TSH) < 0.05 mu/l 0.4 - 5.0 mu/l
Free thyroxine (T4) 22 pmol/l 6.5 – 13.0 pmol/l
Anti-thyroid antibody +

Which of the following is the most appropriate intervention?

MRCP2-1624

A 65-year-old woman presents a week after experiencing Campylobacter gastroenteritis with increased thirst and frequent urination. She reports drinking 9-10 glasses of water or tea a day, which is twice her normal intake, and her urine is clear. She also experiences fatigue and occasional leg cramps. On examination, she appears euvolaemic with moist mucosa and no oedema. Her blood pressure is 105/90 mmHg and heart rate is 67/min. Lab results show low potassium levels and a pending water deprivation test. What is the most likely cause of her symptoms?

MRCP2-1609

A 12-year-old boy of Greek origin presents to the Endocrinology Clinic with delayed growth and development. He has beta-thalassaemia and requires regular blood transfusions to maintain his haemoglobin (Hb) in the range of 90-100 g/l. Blood tests are ordered and the results are as follows:
Haemoglobin (Hb): 95 g/l (normal range: 115-155 g/l)
White cell count (WCC): 7.1 × 109/l (normal range: 4.0-11.0 × 109/l)
Platelets (PLT): 174 × 109/l (normal range: 150-400 × 109/l)
Sodium (Na+): 130 mmol/l (normal range: 135-145 mmol/l)
Potassium (K+): 5.3 mmol/l (normal range: 3.5-5.0 mmol/l)
Creatinine (Cr): 90 μmol/l (normal range: 50-120 µmol/l)
Free T4: 6.5 nmol/l (normal range: 11-22 pmol/l)
9 am cortisol: 52 nmol (normal range: 140-500 nmol/l)
Insulin-like growth factor 1 (IGF-1): 2.5 nmol/l (normal range: 9.3-56 nmol/l)
Follicle-stimulating hormone (FSH): 0.2 U/l (normal range: 1-25 U/l)

What is the most appropriate replacement therapy to initiate in this case?

MRCP2-1610

A 50-year-old presents with hypokalaemia on routine blood tests. There is no history of diarrhoea. The patient has a medical history of type 2 diabetes and Sjogren’s syndrome. They are currently taking hydroxychloroquine and metformin and using topical artificial tears. On examination, there are no notable findings. The blood tests reveal a sodium level of 138 mmol/L (135 – 145), potassium level of 3.0 mmol/L (3.5 – 5.0), urea level of 5.2 mmol/L (2.0 – 7.0), and creatinine level of 89 µmol/L (55 – 120). The venous blood gas shows a pH of 7.27 (7.35-7.45), chloride level of 119 mmol/L (96-106), HCO3- level of 12 mmol/L (22-26), and glucose level of 11.4 mmol/L (< 7.8). The urinalysis reveals a pH of 6.2 (4.5-7.8), negative protein, blood, leucocytes, and nitrites. The 24-hour urine calcium collection is 10.2 mmol (< 7.5). What is the likely diagnosis?