MRCP Part 2 Category: Endocrinology, Diabetes And Metabolic Medicine

MRCP2-1113

A 65-year-old patient with type 1 diabetes presents with hypertension. His blood pressure in clinic is 210/110 mmHg despite treatment with bendroflumethiazide, atenolol and doxazosin.

Investigations demonstrate the following:

Na 136 mmol/L (135-145)

K 3.5 mmol/L (3.5-5.0)

Urea 8.9 mmol/L (3.0-8.0)

Creatinine 132 µmol/L (70-120)

Urinary metanephrines Mets 700 nmol/24 hr (<2000) Normets 3277 nmol/24 hour (<4900) Urinary free cortisol 250 nmol/L (<248) Plasma renin <0.05 mU/L (5.4-60 upright) (5.4-30 after 1 hour rest) Aldosterone 1258 pmol/L (100-450 adults overnight) (100-800 random sample/upright) What is the most likely cause of hypertension in this patient?

MRCP2-1114

A 56-year-old woman with a six year history of type 2 diabetes presents to the Emergency Department with symptoms of central crushing chest pain, sweating, and pre-syncope. She is currently taking metformin 1 g BD for diabetes and amlodipine and valsartan for hypertension. On examination, her BP is 130/70, pulse is 85 and regular, and heart sounds are normal. Investigations reveal an HbA1c of 53 mmol/mol and a hsTroponin level of 1.2 (<0.05). What is the most appropriate way to manage her blood glucose control? Hb 137 g/l (115-160) WCC 7.0×10(9)/l (3.8-10.8) PLT 199×10(9)/l (150-450) Na 140 mmol/l (135-145) K 5.0 mmol/l (3.5-5.5) Bicarbonate 23 mmol/l (18-28) Cr 105 micromol/l (50-90) ECG Sinus rhythm, anterior T wave inversion

MRCP2-1115

A 16-year-old boy presents to the Emergency Department with polyuria, polydipsia, and chronic headaches. He also reports experiencing some vision difficulties recently. He has no significant medical history.

Upon examination, the patient appears healthy with a blood pressure of 136/78, pulse of 82 bpm, and temperature of 36.9°C. Pupils were equal and reactive to light and accommodation, and fundoscopy did not reveal any abnormalities.

Lab results showed:
– Haemoglobin: 132 g/L (130-180)
– White cell count: 7.9 ×109/L (4-11)
– Platelets: 290 ×109/L (150-400)
– Serum sodium: 150 /L (137-144)
– Serum potassium: 4.2 /L (3.5-5.0)
– Serum urea: 4.8 /L (2.5-7.5)
– Serum creatinine: 68 Umol/L (60-110)
– Fasting plasma glucose: 5.5 mmol/L (3-6)
Urinalysis results are pending.

What is the most likely visual field defect in this case?

MRCP2-1116

A 64-year-old woman presents to the Endocrine Clinic with hypercalcaemia and hypophosphataemia. She reports feeling tired and thirsty lately. On examination, her blood pressure is 122/72 mmHg, pulse is 70 bpm and regular, and BMI is 23 kg/m2. Primary hyperparathyroidism is suspected. When should surgical referral be considered?

MRCP2-1101

A 68-year-old man comes to the Outpatient Clinic complaining of right iliac fossa abdominal pain and watery diarrhoea that has been going on for 10 months. He used to be a heavy drinker, consuming 40 pints of beer a week, but has cut back to 1 pint a day for several years. Lately, he has noticed that his symptoms worsen when he drinks alcohol, so he has stopped completely. His wife has noticed that he has lost weight recently, but he cannot say how much. He has never smoked, but his wife has observed some episodes of wheezing. During the abdominal examination, a 3 cm hepatomegaly and an indistinct mass in the right iliac fossa were found. Although urea and electrolytes, liver function tests, and full blood count were normal, a small-bowel barium examination revealed a submucosal mass in the ileum. What is the probable diagnosis?

MRCP2-1117

A 55-year-old male presents with weight loss and agitation. Upon examination, a fine tremor, goitre, and tachycardia are observed. Further investigations confirm thyrotoxicosis with positive TSH receptor autoantibodies. The patient decides to undergo radioactive iodine treatment. What is the correct statement regarding therapy for this patient?

MRCP2-1102

A 56-year-old woman presents to the cardiology clinic with echocardiogram results indicating cardiomyopathy. She was referred after experiencing shortness of breath and suspected heart failure. Her medical history includes hypertension, palpitations, and anxiety. Recently, she has been experiencing tremors, weight loss, sweating, and heat intolerance, and was diagnosed with hyperthyroidism and started on carbimazole. What is the anticipated prognosis for her cardiac condition?

MRCP2-1118

A 42-year-old woman presents to the endocrinology clinic with a 6-week history of weight gain and fatigue. Her vital signs are stable, but her blood pressure is elevated. Laboratory tests reveal hyperglycemia and a low-dose dexamethasone suppression test shows elevated cortisol levels. What is the recommended next step in her evaluation?

MRCP2-1103

A 25-year-old man presents to the Clinic with a history of infertility. His GP had noted that the patient has gynaecomastia. He had a tonsillectomy at age 10, and had his appendix removed aged 18. Otherwise, he has no past history of note. She is not taking any regular medications.
On examination, he is overweight with acne and sparse hair growth on his face and body. His testicular volume is less than 5 ml.
Investigations reveal the following:
Investigations:
9 am testosterone 3 nmol/l 6-27 nmol/l
Luteinising hormone (LH) Elevated
Follicle stimulating-hormone (FSH) Elevated
What is the likely underlying diagnosis?

MRCP2-1119

A 35-year-old female patient visits her GP with complaints of fatigue and general discomfort following a recent viral illness. She also reports experiencing pain in her lower jaw. Upon examination, the GP notes tenderness and nodularity in the patient’s thyroid gland. The patient’s TSH level is measured at < 0.05 mU/l (normal range: 0.4-5.0 mU/l), while her ESR is elevated at 45 mm/hour and a technetium scan shows decreased thyroid uptake. What is the most likely diagnosis?