MRCP Part 2 Category: Endocrinology, Diabetes And Metabolic Medicine

MRCP2-1601

A 55-year-old woman has been referred by an orthopaedic surgeon for advice regarding her Colles’ fracture that occurred eight weeks ago. The radiologist had reported significant osteopaenia at the time of her fracture. A DEXA scan was performed, revealing a T score of -2.6 at the hip and -1.9 at the lumbar spine.

She is a smoker, consuming approximately 15 cigarettes per day, and has a body mass index of 21 kg/m2. She has been Postmenopausal for two years, with no noticeable symptoms, and had a benign breast lump removed 18 months ago. She is currently taking aspirin, atenolol, and GTN spray for her angina, which she only uses occasionally.

What would be the most appropriate treatment plan for this patient?

MRCP2-1602

A 65-year-old man visits the clinic with a complaint of pain in his left hip and pelvis. He has a medical history of benign prostatic hypertrophy and is currently taking finasteride. Upon examination, there are no notable findings except for a limp and limited hip flexion on the left side due to bony pain. The following investigations were conducted: haemoglobin level of 117 g/L (135-177), white cell count of 8.1 ×109/L (4-11), platelets of 196 ×109/L (150-400), sodium of 139 mmol/L (135-146), potassium of 4.2 mmol/L (3.5-5), creatinine of 112 µmol/L (79-118), alkaline phosphatase of 322 U/L (39-117), and calcium of 2.3 mmol/L (2.20-2.61). Which treatment option is most likely to be effective?

MRCP2-1603

A middle-aged woman presents to the clinic with a diagnosis of PCOS and expresses her desire for treatment. She shares that her excessive facial hair and acne are causing her significant distress. Her BMI is 25 and she is not planning to have children. She is currently taking the COCP.
What would be the most suitable recommendation to provide to this patient?

MRCP2-1604

A 22-year-old woman presents to the Endocrine Clinic with complaints of acne, hirsutism, irregular periods, and being overweight. She has a history of heavy periods and currently does not engage in sexual activity.

On examination, she has a male pattern of hirsutism and acne, and her BMI is 32 kg/m2. Her blood pressure is 155/90 mmHg, and her pulse is 75 bpm and regular. Laboratory investigations reveal elevated levels of FSH, LH, and testosterone.

What is the most appropriate intervention to control her symptoms?

MRCP2-1605

A 57-year-old man has been referred to the well man clinic due to his obesity, as registered by the nurse at his local surgery. He has a medical history of hypertension and takes ramipril and indapamide. During examination, his blood pressure is 155/82 mmHg, pulse is 78 and regular, and his BMI is 32. The following investigations were conducted: haemoglobin, white cell count, platelets, sodium, potassium, creatinine, and glucose.

Haemoglobin: 137 g/L (135 – 177)
White cell count: 7.0 ×109/L (4 – 11)
Platelets: 179 ×109/L (150 – 400)
Sodium: 141 mmol/L (135 – 146)
Potassium: 3.9 mmol/L (3.5 – 5)
Creatinine: 110 µmol/L (79 – 118)
Glucose: 6.6 mmol/L (<7.0) What is the most appropriate way to manage this patient?

MRCP2-1597

A 30-year-old female comes in for her annual check-up. She was diagnosed with diabetes mellitus at age 16 and is currently being treated with human mixed insulin twice daily. She has been experiencing dysuria for the past year and has received treatment with trimethoprim four times for cystitis. On examination, two dot haemorrhages are seen bilaterally on fundal examination, but her blood pressure is normal at 116/76 mmHg. Her test results show elevated HbA1c levels, fasting plasma glucose, and glucose in her urine, but her serum sodium, potassium, urea, and creatinine levels are within normal range. Her 24-hour urine protein level is slightly elevated. What is the best course of treatment to prevent the progression of renal disease?

MRCP2-1598

A 28-year-old woman is referred to the Pregnancy Diabetes Clinic after two weeks of diet and exercise failed. Her first child was born at a normal size. She is currently 20 weeks pregnant and has no significant medical history. The following investigations were conducted:

Investigation Result
Fasting plasma glucose 6.9 mmol/l
Oral glucose tolerance test at 2 hours 11.4 mmol/l

What is the next best course of action in this scenario?

MRCP2-1599

A 55-year-old woman with Graves’ disease presents for a check-up on her thyroid status. She is on propranolol and carbimazole. During the visit, she reports experiencing eye pain and double vision, especially when looking to the sides. Upon examination, there is significant proptosis. Her blood pressure is 122/82, pulse is regular at 60. Despite using artificial tears and eye patches, she has not found relief. What is the first-line treatment to improve her ophthalmopathy?

MRCP2-1600

A 63-year-old man with a history of type 2 diabetes presents at the clinic for a check-up. He is currently being treated with BD mixed insulin and metformin to prevent weight gain associated with insulin use. The patient has a medical history of an inferior myocardial infarction and severe narrow-angle glaucoma. Recently, he has been experiencing severe burning pain in both of his lower legs.

During the examination, the patient’s blood pressure is 142/82 mmHg, pulse is 70 and regular. He has lost sensation below the knees in both legs. The following investigations were conducted:

– Haemoglobin: 127 g/L (135-177)
– White cell count: 6.9 ×109/L (4-11)
– Platelets: 189 ×109/L (150-400)
– Sodium: 138 mmol/L (135-146)
– Potassium: 4.9 mmol/L (3.5-5)
– Creatinine: 143 µmol/L (79-118)
– HbA1c: 63 mmol/mol (<48) or 7.9% (<6.5) According to NICE guidance, what is the most appropriate way to manage his neuropathic pain?

MRCP2-1593

An 80-year-old man comes to the endocrine clinic for evaluation. He has been taking amiodarone for the past few months for short episodes of VT diagnosed after a heart attack. Over the last 2 months, he has experienced weight loss and heat intolerance, along with short runs of an irregular, fast heartbeat. During the clinic visit, his BP is 112/82, pulse is 88 and regular, and his BMI is 21. Thyroid function testing reveals an abnormality, with a suppressed thyroid-stimulating hormone (TSH) suggestive of thyrotoxicosis. Radioiodine uptake scan is normal, as is serum interleukin 6 (IL-6). A recent ECHO cardiogram showed an ejection fraction of 38%.
After a repeat ECHO cardiogram and a 72 h tape, which shows paroxysmal AF but no episodes of VT, the cardiologist discontinues his amiodarone. What is the best initial therapy for this patient?