Archives: MRCP Part 2

MRCP2-1634

A 25-year-old man visits his GP for a routine check-up. During the appointment, the GP notices that his glucose levels are slightly elevated. The man is referred to the Diabetic Clinic, where you conduct a thorough medical history.

The man has no previous medical conditions and is generally healthy. However, his father and grandfather both have diabetes, which was diagnosed at a young age. His father manages his diabetes through diet and exercise, while his grandfather requires insulin. The man’s family is health-conscious and maintains a BMI around 20 kg/m2.

Upon testing, the man’s fasting venous glucose is 10 mmol/l. What is the most likely diagnosis in this case?

MRCP2-1635

A 32-year-old man comes to the clinic complaining of recurrent palpitations. Despite being able to perform his job as a construction worker, he feels increasingly fatigued. He has no significant medical history and is not taking any medications.
During the examination, his blood pressure is 118/70 mmHg, with a pulse of 80/min and regular. His BMI is 27. His TSH level is 0.2 mU/l (0.4–5), free T4 is 19.5 pmol/l (10–22), and free T3 is 9.0 pmol/l (5–10).
What is the most likely diagnosis?

MRCP2-1636

A 40 year-old woman presents to her GP with a 4 month history of increasing anxiety. On further questioning, she has lost 5 kg of weight over the past 3 months and has been experiencing increased bowel movements and diarrhoea.

Blood tests are performed and reveal:

Hb 13.8 g/dL
Platelets 200 * 109/l
WBC 7.2 * 109/l
Thyroid stimulating hormone (TSH) 0.05 mu/l
Free thyroxine (T4) 18.2 pmol/l
Total triiodothyronine (T3) 12.8 nmol/l Normal range (4.0-8.3 nmol/l)

What is the most appropriate treatment?

MRCP2-1637

A 19-year-old male with no previous medical history presents to the Emergency Department’s resuscitation room for evaluation. Upon assessment, he is found to be febrile, tachycardic, and hypotensive. A widespread, non-blanching, purple rash is also observed. The diagnosis is meningococcal septicaemia, and appropriate treatment is administered. However, the patient’s condition worsens as he develops Waterhouse-Friderichsen syndrome. Which of the following blood test results would be most indicative of his current state?

MRCP2-1638

A 45-year-old female presents with palpitations and mild weight loss. She has no significant medical history but regularly takes supplements from a health food shop. She does not smoke and drinks alcohol infrequently. Her maternal aunt has a history of underactive thyroid, but otherwise, there is nothing noteworthy in her family history.

During examination, her pulse is 96 beats per minute, and her blood pressure is 122/76 mmHg. She exhibits fine tremors in her outstretched hands and slight lid lag, but no exophthalmos or goitre is palpable.

Thyroid function tests reveal:
– Free T4: 29.3 pmol/L (normal range: 10 – 22)
– Free T3: 5.3 pmol/L (normal range: 3.5 – 5.5)
– TSH: <0.02 mU/L (normal range: 0.4 - 5.0)
– Thyroglobulin: Undetectable

What is the most likely diagnosis?

MRCP2-1639

A 65-year-old lady presents for a follow-up appointment. She had presented 6 months previously under the acute medical take with headaches, sweating, abdominal pain and wild fluctuations in blood pressure. She is currently being followed up by the appropriate surgical team and her symptoms are currently well controlled with medical treatments. On examination today, you note a lump in her anterior neck and you are given the following blood tests:

Calcium (corrected) 3.68 mmol/l
Phosphate 0.38 mmol/l
Vitamin D3 115 nmol/l (75-200 nmol/l)
Parathyroid hormone 19 pmol/l (0.8 – 8.5 pmol/l)

You have referred the patient to endocrine surgeons for neck biopsies and urgent review. Her daughter, who came with her to the consultation, is worried about her own risk of developing similar symptoms in the future. What advice can you offer the daughter?

MRCP2-1640

A 35-year-old woman presents to her GP with a three-month history of frequent loose stools and occasional episodes of facial flushing. She has no significant medical history, has not traveled recently, and is not taking any medications. On examination, she appears dehydrated and is referred to the hospital’s AMU.
Upon admission, blood tests reveal the following results:

Arterial pH 7.33 7.35 – 7.45
Arterial pCO2 4.5 kPa 4.7 – 6.0 kPa
Arterial pO2 13.8 kPa > 10.5 kPa
Arterial HCO3 17.8 mmol/l 22.0 – 26.0 mmol/l

Sodium (Na+) 139 mmol/l 135 – 145 mmol/l
Potassium (K+) 3.2 mmol/l 3.5 – 5.0 mmol/l
Urea 6.8 mmol/l 2.5 – 6.5 mmol/l
Creatinine (Cr) 91 μmol/l 50 – 120 μmol/l
Calcium (Ca2+) 2.72 mmol/l 2.2 – 2.7 mmol/l
Magnesium (Mg2+) 0.47 mmol/l 0.6 – 1.1 mmol/l
Further investigations reveal a negative stool culture for bacterial and fungal infections, and a CT scan shows a lesion on her pancreas.
What is the most likely diagnosis?

MRCP2-1641

A 32-year-old pregnant woman at 10 weeks gestation seeks advice on how to rule out gestational diabetes. She has a BMI of 28.7 and a family history of type 1 diabetes in her cousin and breast cancer in her aunt. She has had two previous pregnancies, one of which ended in miscarriage at 8 weeks and the other resulted in a healthy baby with a birth weight of 4.6kg. What testing regimen would be most appropriate for ruling out gestational diabetes in this patient?

MRCP2-1642

A 50 year-old woman presents with a two day history of nausea and fever. On admission she is confused and her husband states that she was recovering from a recent upper respiratory tract infection and sore throat. He also mentions she has previously been experiencing episodes of diarrhoea and palpitations over the last three months.

Examination reveals a temperature of 40.6ºC, pulse rate of 160 beats per minute and blood pressure of 110/70 mmHg. Her pulse is irregularly irregular. Heart sounds 1 and 2 are present with no added sounds, lung fields are clear and her abdomen is soft and nontender, with bowel sounds being present.

Blood tests are taken and reveal:

Hb 13.2 g/dL
Platelets 180 * 109/l
WBC 10.2 * 109/l
Na+ 135 mmol/l
K+ 4.2 mmol/l
Urea 7.2 mmol/l
Creatinine 132 µmol/l
Thyroid stimulating hormone (TSH) 0.03 mu/l
Free thyroxine (T4) 31 pmol/l
Total thyroxine (T4) 220 nmol/l

What is the most appropriate immediate treatment?

MRCP2-1643

A 20-year-old woman presents to the endocrinology clinic with a history of feeling weak and needing a sweet drink to improve. This has been happening frequently since she was rejected from applications to medical school. She has a previous history of anxiety, but her parents have become concerned after using her sister’s glucose monitoring equipment (who has type 1 diabetes) and finding her capillary glucose as low as 2 mmol/l. They are worried that she may have an insulinoma after reading about it on the internet and have requested an endocrinology referral from the GP. What is the most appropriate investigation to rule out insulinoma?