Archives: MRCP Part 2

MRCP2-1620

A 67-year-old lifelong smoker presents with a 3-week history of gradually worsening confusion, abdominal discomfort and constipation. He admits to a chronic cough which has worsened over the past nine to twelve months, and that he has lost 7 kg in weight.
On examination, his blood pressure (BP) is 148/80, with pulse 76 and regular. There is bilateral wheeze on auscultation of the chest consistent with COPD. He looks thin, with a BMI of 20.
Investigations:
s
Sodium (Na+) 137 mmol/l 135 – 145 mmol/l
Potassium (K+) 4.2 mmol/l 3.5 – 5.0 mmol/l
Creatinine (Cr) 110 µmol/l 50 – 120 µmol/l
Urea 7.5 mmol/l 2.5 – 6.5 mmol/l
Corrected calcium (Ca2+) 3.02 mmol/l 2.2 – 2.7 mmol/l
Albumin 30 g/l 35 – 55 g/l
Alkaline phosphatase (ALP) 155 u/l 30 – 150 u/l
Parathyroid hormone (PTH) 0.7 pmol/l 0.9 – 5.4 pmol/l
What is the most likely cause of his hypercalcaemia?

MRCP2-1621

A frail 83-year-old gentleman was brought in by his son, who found him on the floor in his apartment. He had tripped in a mechanical and had been unable to get back up, lying on the floor for the past 3 days. On examination, he appears extremely dehydrated but has no specific focal weakness, systemic examination is unremarkable. He has sustained no musculoskeletal injuries. His blood tests are as follows:

Na+ 168 mmol/l
K+ 6.0 mmol/l
Urea 24 mmol/l
Creatinine 260 µmol/l (baseline 107 three months ago)
Creatinine kinase 11,000 mmol/l

ECG shows normal sinus rhythm at 99/ minute.

You diagnose him with rhabdomyolysis and an acute kidney injury, likely of a pre-renal cause. Intravenous fluid rehydration is initiated with intravenous 5% dextrose. You ask your colleague to check the patient’s blood tests in 12 hours.

What is the reason for correcting the patient’s hypernatraemia?

MRCP2-1622

A 35-year-old construction worker presents for review. He is 6 feet 2 inches tall and has signs of delayed puberty and infertility on examination, notably small testes with scanty pubic hair.
Investigations:
s
Follicle-stimulating hormone (FSH) 40 u/l 1 – 7 u/l
Testosterone 6 nmol/l 9 – 25 nmol/l
What is the most likely diagnosis based on this clinical presentation and laboratory results?

MRCP2-1623

A 38-year-old woman presents to the emergency department with a suspected drug overdose and reduced GCS. She has a history of type 2 diabetes and takes gliclazide. Upon examination, she appears pale and sweaty. During her initial assessment, the following result is obtained:

Blood glucose 2.0 mmol/L (>3.9 mmol/L)

After receiving an infusion of 50% dextrose, her glucose level is rechecked:

Blood glucose 2.5 mmol/L (>3.9 mmol/L)

What other treatment options should be considered to stop the underlying process?

MRCP2-1624

A 65-year-old woman presents a week after experiencing Campylobacter gastroenteritis with increased thirst and frequent urination. She reports drinking 9-10 glasses of water or tea a day, which is twice her normal intake, and her urine is clear. She also experiences fatigue and occasional leg cramps. On examination, she appears euvolaemic with moist mucosa and no oedema. Her blood pressure is 105/90 mmHg and heart rate is 67/min. Lab results show low potassium levels and a pending water deprivation test. What is the most likely cause of her symptoms?

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?