MRCP Part 2 Category: Endocrinology, Diabetes And Metabolic Medicine

MRCP2-1159

A 67-year-old man presents to the emergency department with sudden onset epigastric pain that radiates to his back and has been unremitting for the past day. He has also been experiencing headaches, low mood, and nocturia for several months. He appears unwell on examination with dry mucous membranes and tachycardia. Urinalysis shows glucose, protein, and ketones. His blood work reveals elevated glucose, creatinine, and low bicarbonate and albumin levels. Which diagnostic test would be most helpful in determining his diagnosis?

MRCP2-1175

A 72-year-old woman who has been on long-term amiodarone therapy for paroxysmal AF presents to the clinic with complaints of increasing palpitations, weight loss, and heat intolerance over the past few months. During the examination, her blood pressure is 149/89 mmHg, pulse is 85 and regular, and she appears sweaty with a tremor. A TSH test reveals a measurement of 0.1 IU/L. What is the most effective way to differentiate between type 1 and type 2 Amiodarone-induced thyrotoxicosis (AIT)?

MRCP2-1160

A 42-year-old woman complains of decreased sexual desire, dryness in her vagina, and absence of menstruation for the past 6 months. Recently, she has noticed milk leakage from her breasts with minimal nipple stimulation. She has a history of taking birth control pills. Her prolactin level is 4800 micro IU/L, and she insists that she cannot be pregnant as she has taken a home pregnancy test, which came back negative. Her blood pressure is 130/70 mmHg, pulse is 72/min and regular, and her BMI is 24. Which test is most likely to provide a diagnosis?

MRCP2-1176

A 23-year-old male patient presents to his family doctor with concerns about delayed puberty. He has difficulty forming romantic relationships and feels that things always fall apart when things become physical. Upon examination, he has minimal body hair and an underdeveloped penis with small testicles. His blood pressure and body mass index are within normal limits. He also reports a loss of sense of smell. The following investigations were conducted:

Testosterone: 6 nmol/L (normal range: 9-35 nmol/L)
Follicle-stimulating hormone (FSH): 0.8 U/L (normal range: 1-25 U/L)
Luteinizing hormone (LH): 0.6 U/L (normal range: 1-70 U/L)
Thyroid-stimulating hormone (TSH): 1.1 µU/L (normal range: 0.17-3.2 µU/L)

What is the most likely diagnosis based on this clinical presentation?

MRCP2-1161

A 35-year-old married man presents to the Endocrine Clinic with recent symptoms of sweating, weight loss and palpitations. He tells you that his father has a history of thyroid disease.
On examination, he has a BMI of 22, there is no palpable goitre and a tremor is noted.
Investigations:
Haemoglobin (Hb) 128 g/l 135 – 175 g/l
White cell count (WCC) 7.2 × 109/l 4.0 – 11.0 × 109/l
Platelets (PLT) 250 × 109/l 150 – 400 × 109/l
Sodium (Na+) 142 mmol/l 135 – 145 mmol/l
Potassium (K+) 4.0 mmol/l 3.5 – 5.0 mmol/l
Creatinine (Cr) 80 μmol/l 50 – 120 μmol/l
Glucose 6.2 mmol/l 3.9 – 7.1 mmol/l
Thyroid-stimulating hormone (TSH) < 0.05 mu/l 0.5 - 4.0 mu/l
Free Thyroxine (FT4) 32.1 pmol/l 10 – 22 pmol/l
Thyroid scintography revealed decreased uptake
Which of the following is the most appropriate next investigation?

MRCP2-1177

You are asked to review an 83-year-old woman on the care of the elderly ward as serum sodium results are low. The patient was admitted six hours ago with a diagnosis of community-acquired pneumonia and exacerbation of congestive cardiac failure. She presented with a productive cough, shortness of breath and leg swelling. She has a past medical history of multiple myocardial infarcts five years ago and has subsequently developed heart failure. She also has had osteoarthritis, hypertension and high cholesterol. She takes aspirin, ramipril, furosemide, bisoprolol, omeprazole and atorvastatin. On examination, she has a raised JVP and bilateral crepitations to midzones bilaterally as well as oedema to the sacrum.

Blood tests:
Hb 120 g/l
Platelets 480 * 109/l
WBC 14.2 * 109/l
Na+ 126 mmol/l
K+ 3.5 mmol/l
Urea 6.3 mmol/l
Creatinine 84 µmol/l

Urinary sodium: 16 mmol/l

What is the most likely cause of hyponatraemia?

MRCP2-1162

A 31-year-old woman has been diagnosed with a phaeochromocytoma by her general physicians and is now seeing you for a specialist endocrinology appointment. She is currently taking phenoxybenzamine for adrenergic blockade and awaiting surgery. During her visit, her doctors express concern over her elevated calcium levels, which are at 2.75 mmol/l. Upon examination, you detect a hard mass on the right side of her thyroid and her blood pressure is elevated at 148/88 mmHg. What is the most crucial test for confirming her diagnosis?

MRCP2-1163

A 60-year-old man presents to clinic with complaints of tiredness, weakness, and loss of body hair. He recently went through a divorce and attributes the loss of sexual function as one reason for the split. He has a history of mild essential hypertension and takes amlodipine. On examination, his pulse is 90 bpm and BP is 100/50 mmHg. He has normal secondary sexual characteristics, but his body hair is fine and sparse. Additionally, he has bitemporal hemianopia. Routine bloods show mildly elevated potassium of 5.5 mmol/l, and TSH is within the normal range. What would be the most useful test from those listed?

MRCP2-1164

A 48-year-old female patient presents with the following thyroid function test results:
TSH <0.03 IU/L (0.5-4.5)
fT4 18.8 pmol/L (12.0-16.0)
fT3 6.2 pmol/L (3.5-5.0)

What is the probable diagnosis for this patient?

MRCP2-1165

A 50-year-old man presents to his GP with a persistent cough and shortness of breath for the past 2 weeks. He is a smoker of 15 cigarettes per day for the past 30 years. The GP initially diagnosed a mild viral chest infection but the patient returned 2 weeks later with symptoms of thirst, polyuria, and muscle weakness. His blood pressure was elevated and ankle oedema was present. Blood tests revealed hyperglycaemia and abnormal electrolyte levels. What is the most probable diagnosis?