MRCP Part 2 Category: Endocrinology, Diabetes And Metabolic Medicine

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?

MRCP2-1601

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?

MRCP2-1593

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?

MRCP2-1594

A 63-year-old woman presents to the diabetes nephropathy clinic for follow-up. She has a history of chronically elevated creatinine and microalbuminuria. Her current medications include basal bolus insulin, ramipril 10 mg, amlodipine 5 mg, and bisoprolol 10 mg. On examination, her blood pressure is 155/72 mmHg, pulse is 72 and regular, and she has neuropathy to the mid shin.

Further investigations reveal a haemoglobin level of 110 g/L (115 – 160), white cell count of 8.8 ×109/L (4 – 11), platelets of 199 ×109/L (150 – 400), sodium of 138 mmol/L (135 – 146), potassium of 5.2 mmol/L (3.5 – 5), and creatinine of 299 µmol/L (240 one year earlier) (79 – 118).

What is the appropriate management of her blood pressure?

MRCP2-1595

A 50-year-old man with a 22 year history of type 1 diabetes presents at the clinic for a check-up. His recent HbA1c reading was 66 mmol/mol. He reports experiencing regurgitation of food, indigestion, and difficulty determining the correct dose of meal time insulin. During the examination, his blood pressure is measured at 135/90 mmHg with a postural drop of 20 mmHg. Additionally, he displays bilateral sensory loss to the mid shin on both legs. What is the most appropriate initial treatment for this patient?

MRCP2-1596

A 60-year-old man with type II diabetes mellitus presents to the Diabetic Clinic for follow-up. He has been diabetic for 8 years, diet controlled for 3 years and on gliclazide and metformin since then. However, he has missed several follow-up appointments. On examination, his blood pressure is 126/78 mmHg and there is no evidence of peripheral neuropathy. Previous investigations showed a HbA1c of 44.82 mmol/mol (6.2%), negative protein and glucose, and normal electrolyte and renal function. A 24-hour urine collection revealed 200 mg of albumin. What is the most effective management strategy to improve his overall prognosis for renal and other complications?

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?