Archives: MRCP Part 2

MRCP2-1515

A 16-year-old girl comes to your clinic with her parents. They recently moved from Pakistan. Her teachers have expressed concerns about possible learning difficulties, prompting her parents to seek medical advice.

During the examination, you observe that she is 1.50m tall and weighs 70kg. Her BMI is 31.1kg/m². The cardio-respiratory examination is normal, but you notice some shortening of the 5th metacarpals on both hands.

Blood tests have been conducted, and the results are as follows:

Parathyroid hormone 80 pg/mL (14-65)
Adjusted calcium 2.1 mmol/L (2.2-2.6)
Phosphate 2.05 mmol/L (0.97-1.45)

Based on the information provided, what is the most likely underlying diagnosis?

MRCP2-1516

A 38-year-old man is referred to the outpatient department by his GP due to a loss of libido and impotence. He works in a high-stress job as a financial analyst and has a three-year pack year history. He drinks three glasses of wine per night.

Blood tests show a prolactin level of 3200 mU/l (<360), normal thyroid function tests, MCV 98 fl, and low testosterone. What would be the most suitable investigation in this case?

MRCP2-1517

A 28-year-old female presents to the clinic with complaints of anxiety, palpitations, and a resting tremor that have been present for the past two weeks. She also reports flu-like symptoms and pain in her anterior neck. Upon examination, tenderness is noted over her thyroid. Her blood pressure is 115/88 mmHg, and she has a fine tremor at rest, sweaty palms, and a heart rate of 88 beats per minute. Her TSH level is <0.05 U/ml. What is the most appropriate course of action for this patient?

MRCP2-1518

A surgical FY1 requests your expertise in reviewing a preoperative ECG for a 20-year-old patient admitted with suspected appendicitis. The ECG shows a prolonged QT interval and the adjusted calcium level is 2.02 mmol/l. The FY1 also notes that the patient’s outer two knuckles appear as dimples and their BMI is 29 kg/m². Blood tests reveal an elevated PTH level of 69 pmol/L (normal range = 0.8 – 8.5), phosphate level of 2.0 mmol/l, and ALP level of 130 u/l. Based on these findings, what is the most likely cause of the patient’s hypocalcaemia?

MRCP2-1519

A 25-year-old woman presents to her GP with tiredness, weight loss, and diarrhoea. She has also been experiencing heavy periods over the past few months. On examination, she appears tanned, but is very thin and emaciated. Her BP is 115/80 mmHg, pulse is 84 bpm and regular, and she has a postural drop of 20 mmHg on standing. Investigations reveal abnormal results for haemoglobin, potassium, ferritin, albumin, ALT, TSH, and glucose. Based on these findings, what is the most likely diagnosis for this patient?

MRCP2-1520

A 30-year-old man presents to the clinic with his partner due to difficulties with fertility, having tried to conceive for over 24 months with no success. He reports decreased libido and trouble maintaining his erection. He has also experienced problems with his sense of smell for as long as he can remember. On physical examination, his blood pressure is 120/70 mmHg, with a pulse of 75/min. He has sparse secondary sexual hair and a small penis.

Investigations reveal a hemoglobin level of 124 g/l, a white blood cell count of 7.1 x 109/l, and a platelet count of 203 x 109/l. His sodium and potassium levels are within normal limits, but his creatinine level is 110 µmol/l. His TSH level is 1.2 U/l (0.5-4.5 U/l), and his free T4 level is 12 pmol/l (10-22). His testosterone level is 7.0 nmol/l (9–35), while his FSH and LH levels are both low.

What is the most likely diagnosis?

MRCP2-1501

A 25-year-old man with a history of Von Hippel Lindau syndrome presents to his GP for a routine mood review. He has previously been well but has retinal haemangiomas. He is currently taking venlafaxine for improved mood following a recent relationship break down. Despite using mindfulness to control panic attacks, he still experiences palpitations and clamminess.

During the examination, the patient appears alert and in good health. However, his blood pressure is measured at 170/110 mmHg. Fundoscopy reveals no haemorrhages or cotton wool spots, and his visual acuity is 6/6 bilaterally. There are no palpable masses in his abdomen.

The patient’s blood test results show normal levels of Na+, K+, HCO3, urea, and creatinine, but his TSH level is 3.2 mU/l (range 0-4). An ECG reveals large QRS complexes consistent with left ventricular hypertrophy.

What is the most likely explanation for the patient’s symptoms?

MRCP2-1502

A 25-year-old woman presents to the Emergency department following a collapse at the local supermarket. She reports feeling weak and fatigued most of the time and rarely seeks medical attention. She has no regular medication. On examination, her blood pressure is 100/70 mmHg, pulse is 80 beats per minute and regular. She has a BMI of 21 kg/m² and no abnormal physical signs are noted.

Investigations

Na+ 140 mmol/l
K+ 3.1 mmol/l
HCO3- 32 mmol/l
Urea 5.9 mmol/l
Creatinine 85 µmol/l

What is the most likely diagnosis?

MRCP2-1503

A 24-year-old woman with a history of polycystic kidney disease and chronic kidney disease presents to the Endocrinology Clinic for her annual review. She reports experiencing intermittent abdominal pain and generalised aches over the past two weeks, as well as feeling thirsty. She is currently on the waiting list for a kidney transplant. Her routine blood tests reveal several abnormalities, including a low haemoglobin level, high white cell count and platelet count, elevated urea and creatinine levels, and a high calcium level. What condition has this patient developed that could explain the abnormal calcium level?

MRCP2-1504

A 63-year-old male, who recently immigrated from India, presents with a 5-day history of feeling generally unwell. His niece, who is with him at the hospital, denies any recent productive cough, diarrhea, vomiting, or dysuria. The patient has been gradually becoming more malaised over the past 5 days and has not been eating or drinking well. He has no known medical history. On examination, he has dry mucous membranes and cool peripheries, and his JVP is +1 cm above the angle of Louis. Heart sounds, chest, and abdomen are unremarkable. Urine dip and chest radiograph results are pending. The patient’s blood tests reveal:

– WBC: 16 * 109/l
– Neutrophils: 14.8 * 109/l
– Na+: 152 mmol/l
– K+: 3.7 mmol/l
– Urea: 22 mmol/l
– Creatinine: 208 µmol/l
– CRP: 38 mg/l
– Glucose: 38 mmol/l
– Ketones: 2.8 mmol/l

Arterial blood gases:

– pH: 7.31
– PaO2: 20.2 kPa
– PaCO2: 3.0 kPa
– Bicarbonate: 16 mmol/l
– Lactate: 4 mmol/l

What is the likely diagnosis that unifies these symptoms and test results?