MRCP Part 2 Category: Endocrinology, Diabetes And Metabolic Medicine

MRCP2-1079

A 55-year-old male presents with a six month history of weight loss and thirst. He has a past history of hypertension and is currently taking bendroflumethiazide and ramipril. He has lost approximately 4 kg in weight over this time and finds that he needs to get up in the night to pass urine twice.

On examination, his pulse is 80 bpm regular, his blood pressure is 138/84 mmHg and he has a BMI of 23.5 kg/m2. Dipstick urine analysis reveals ++ glucose.

His investigations reveal:
– Fasting plasma glucose 13.3 mmol/L (3.5-6)
– HbA1c 74 mmol/mol (20-46)
– 8.9% (<6) What is the most appropriate investigation to determine the cause of this patient’s diabetes?

MRCP2-1080

An 84-year-old man presents with fatigue and a history of hypertension and type 2 diabetes mellitus. He takes lisinopril and metformin. His blood pressure is 140/80 mmHg and he appears to be clinically hydrated. Routine blood tests show:
Test Result Normal Range
Sodium (Na+) 128 mmol/L 135-145 mmol/L
Potassium (K+) 4.2 mmol/L 3.5-5.0 mmol/L
Urea 6.8 mmol/L 2.5-6.5 mmol/L
Creatinine 90 µmol/L 50-120 µmol/L
Which laboratory test would be most helpful in determining his fluid balance status?

MRCP2-1081

A 28-year-old female patient presents to her GP with complaints of ongoing fatigue and struggles with weight loss. She frequently feels cold and has been experiencing constipation. After discussing her symptoms with her family, she was advised to seek medical attention as her mother had similar symptoms when diagnosed with Hashimoto’s thyroiditis. What autoantibody is most likely to be present in her blood?

MRCP2-1082

A 30-year-old woman presents to the Emergency Department with complaints of increasing fatigue over the past few weeks. She is now unable to leave her house due to exhaustion, has significant nausea, and has not been able to eat for the past 48 hours. The patient has a history of Hashimoto’s thyroiditis and type 1 diabetes, for which she takes thyroxine and insulin. On examination, her blood pressure is 100/70 mmHg, with a postural drop of 20 mmHg on standing, and her pulse is 90 bpm and regular. Laboratory investigations reveal low haemoglobin, low sodium, high potassium, and high creatinine levels. What is the most likely diagnosis?

MRCP2-1083

A 12-year-old boy is presenting with nocturnal enuresis, poor academic performance, and easy fatigue with physical activity. A full examination, including blood pressure, is unremarkable. Laboratory results show elevated WBC count and high bicarbonate levels. The 24-hour urine test reveals high potassium levels and low sodium levels. What is the likely diagnosis?

MRCP2-1068

A 15-year-old girl presents to the Emergency department with a four day history of nausea and vomiting. She has a 10 year history of insulin-dependent diabetes mellitus and has had multiple admissions for diabetic ketoacidosis due to poor glycaemic control. On examination, she appears alert and oriented with dry mouth but no loss of skin turgor. Laboratory investigations reveal elevated glucose, ketones, and creatinine, as well as low bicarbonate levels. She is treated with intravenous fluids and insulin, which initially improves her symptoms, but nausea and vomiting resume when fluids are discontinued. Seven days later, her blood biochemistry shows abnormal levels of sodium, potassium, urea, and bicarbonate. What single test would be most useful in determining the cause of these biochemical abnormalities?

MRCP2-1084

A 50-year-old man visits the endocrine clinic with difficulty in managing his type 2 diabetes. He has been diagnosed with the condition for five years and is currently taking Metformin 1g BD, Gliclazide 160 mg BD, and Sitagliptin 100 mg OD. As a bus driver, he finds it challenging to control his weight due to his busy shifts, resulting in a BMI of 34 kg/m².

Upon conducting investigations, his serum creatinine levels are at 120 µmol/L (60-110), and his Haemoglobin A1c levels are at 66 mmol/mol (8.2%). What would be the most appropriate next step?

MRCP2-1069

A 28-year-old woman presents to the Emergency department.

She has been experiencing increasing fatigue for the past few months and is now suffering from persistent vomiting. She has lost 6 kg over three months.

During examination, her blood pressure is 100/60 mmHg, pulse is 70 and regular. She appears tanned and has a BMI of 21.

Investigations reveal the following results:
– Haemoglobin: 122 g/L (115-160)
– White cell count: 8.2 ×109/L (4-11)
– Platelets: 222 ×109/L (150-400)
– Sodium: 130 mmol/L (135-146)
– Potassium: 4.0 mmol/L (3.5-5)
– Creatinine: 132 µmol/L (79-118)

Which of the following treatments is most likely to be effective?

MRCP2-1085

A 36-year-old woman presents to the outpatient department with complaints of pain in her calves when walking 50 meters. She has no significant medical history except for a history of migraines. Her family history includes her mother having diabetes and her father dying of a heart attack at the age of 46. She is a heavy smoker, smoking 35 cigarettes per day, and drinks a glass of wine every evening. She works as a financial advisor.

During the examination, the physician observes tendon xanthomas affecting the extensor tendons of her fingers. Additionally, xanthelasma is noticed around both eyes and corneal arcs.

What is the most likely diagnosis?

MRCP2-1070

A 64-year-old man presents with cramps and twitching in his legs after undergoing a thyroidectomy for follicular thyroid cancer. He reports that the surgery went well without complications, but his regular medications were held for one day. He has a medical history of hypertension, vitamin D deficiency, depression, and gout and was taking ramipril, cholecalciferol with calcium, and allopurinol. What is the probable cause of his cramps?