MRCP Part 2 Category: Endocrinology, Diabetes And Metabolic Medicine

MRCP2-1086

A 45-year-old female presented to Endocrinology Clinic with a 4-month history of weight gain, fatigue and headaches. Over the last 4 weeks, she has also experienced galactorrhoea and reduced libido. She was diagnosed with type 2 diabetes and hypertension 2 months ago and is on diet control for both. She is not currently on any regular medications.

During examination, there was evidence of hirsutism and acne, a cervical fat pad, striae on her abdomen and proximal myopathy. Areas of hyperpigmentation were noted on her mucous membrane and palmar creases.

Which of the following investigations will reveal the diagnosis?

MRCP2-1071

A 32-year-old woman is diagnosed with gestational diabetes during her first pregnancy. Her fasting blood glucose level is 5.9mmol/l and her blood glucose level after an oral glucose tolerance test (OGTT) is 8.2mmol/l. She manages her blood glucose levels during pregnancy with diet, exercise, and metformin. At 39 weeks, she gives birth to a healthy baby. On the first day after delivery, her fasting blood glucose level is 5.2mmol/l.

What is the appropriate follow-up monitoring for diabetes in this case?

MRCP2-1087

A 23 year-old man presents with a six week history of increasing thirst and frequency of urinating. The GP suspects diabetes and performs two fasting blood tests on separate days which reveal blood glucose results of 8.9 mmol/l and 9.5 mmol/l. Urinalysis does not detect any ketones or protein in the urine. The patient’s mother had a diagnosis as type 1 diabetes at the age of 21 and his maternal grandfather and aunt also have type 1 diabetes. Due to the family history, the patient’s c-peptide is measured and found to be consistently high on two occasions.

What would be the most appropriate initial treatment for managing this condition, given the likely diagnosis?

MRCP2-1072

A 48 year old woman presents with complaints of excessive thirst and frequent urination. She has a medical history of hypertension, hypercholesterolemia, and bipolar disorder, and a strong family history of diabetes, although she is unsure which type.

The following results were obtained:

– Sodium (Na+): 131 mmol/l
– Urine osmolality: 287 mOsmol/kg (normal range: 300 – 900 mOsmol/kg)
– Plasma osmolality: 287 mOsmol/kg (normal range: 285 – 295 mOsmol/kg)

What is the most likely cause of this patient’s symptoms?

MRCP2-1073

A 56-year-old man with a history of type 2 diabetes is recovering on the surgical ward after experiencing an episode of acute pancreatitis about 4 days ago. He is currently taking metformin, dapagliflozin, and liraglutide for glucose control. During examination, his blood pressure is 135/80 mmHg, pulse is regular at 72, and his body mass index is 35 kg/m². His recent HbA1c is 63 mmol/mol, and his renal function is normal. What is the appropriate course of action for his long-term blood glucose lowering medication?

MRCP2-1074

A 65-year-old male presented with a six month history of polyuria, polydipsia and generalised aches and pains.

He is a known hypertensive for fifteen years and is taking bendroflumethiazide 2.5 mg daily. He has been taking calcium and vitamin D supplements for the last three years as he has a strong family history of osteoporosis.

On examination, his pulse rate is 80 beats per minute and his blood pressure is 150/90 mmHg. Cardiovascular, respiratory and abdominal examination were normal.

Investigations reveal:

Serum sodium 130 mmol/L
Serum potassium 3.1 mmol/L
Serum urea 7.7 mmol/L
Serum creatinine 88 mol/L
Serum corrected calcium 2.9 mmol/L
Phosphate 0.8 mmol/L
PTH 4.5 pmol/L (0.9-5.4)
Urinalysis glycosuria ++

What is the most likely cause of this gentleman’s symptoms?

MRCP2-1075

A 25-year-old nurse collapses at the end of a night shift and is admitted to the hospital. Her capillary blood glucose is measured at 1.2mmol/L and she quickly recovers after receiving IV glucose. A CT scan of her abdomen and pelvis reveals a hypervascular lesion in her pancreas that enhances with contrast. What additional finding would provide the strongest evidence for the probable diagnosis?

MRCP2-1076

You assess a 67-year-old patient in the diabetic clinic who has been diagnosed with type 2 diabetes for 27 years. He has been on various antiglycemic agents including biguanides, sulfonylureas, thiazolidinediones, and insulin. The patient reports painless macroscopic hematuria and is concerned about bladder cancer associated with one of his medications. He requests a referral to a urologist. Which of the following antiglycemic agents is linked to bladder cancer?

MRCP2-1061

A 57-year-old man presents to the GP clinic with facial changes that have developed over the past 6 months. He has a history of hypertension that remains uncontrolled despite adhering to medications, a low-salt diet, and regular exercise.

During his assessment, his vital signs are recorded as follows: temperature 36.7ºC, blood pressure 146/98 mmHg, heart rate 90/min, and respiratory rate 14/min. On examination, his facial features appear coarse and markedly different from his driver’s license photo taken 3 years ago. Additionally, his fingers are swollen, and his skin has thickened.

Further investigations reveal elevated IGF-1 levels and an MRI confirms the presence of a pituitary adenoma. The patient undergoes trans-sphenoidal surgery to remove the tumour.

However, on a follow-up visit 3 months later, his serum IGF-1 levels remain elevated, and he continues to experience the same symptoms as before. A repeat MRI shows no residual tumour.

What is the most appropriate next step in managing this patient?

MRCP2-1062

A 32-year-old woman presents to clinic with headaches and a fasting glucose level of 8.2 mmol/l. She has also noticed a change in her facial features and her shoe size has increased. On examination, she has enlarged hands and feet, as well as bitemporal hemianopia. Her blood pressure is elevated at 150/95 mmHg. An oral glucose tolerance test with growth hormone levels showed a blood glucose of 12.1 mmol/l at 120 min and failure to suppress growth hormone levels. An MRI scan of the pituitary fossa revealed an adenoma that was abutting the optic chiasm. The patient prefers medical therapy over surgery (transphenoidal resection of the adenoma). What is the most appropriate initial medical therapy for her?