A 25-year-old woman with a history of anorexia presents to her primary care physician with vomiting and stomach discomfort. Investigations:
Urea 18 mmol/l 2.5–6.5 mmol/l Creatinine (Cr) 90 µmol/l 50–120 µmol/l Sodium (Na+) 142 mmol/l 135–145 mmol/l Potassium (K+) 3.8 mmol/l 3.5–5.0 mmol/l Corrected calcium (Ca2+) 3.5 mmol/l 2.2–2.6 mmol/l Plasma parathyroid hormone (PTH) 8.5 pmol/l 0.9–5.4 mmol/l Initiation of fluid resuscitation with 0.9% sodium chloride is commenced. What would be the subsequent step in management after fluid resuscitation?
MRCP2-1491
A 45-year-old male presents with a six-month history of impotence and reduced libido. He has been married for 20 years and has two children. He smokes five cigarettes per day and drinks approximately 12 units of alcohol weekly.
On examination, he appears obese but otherwise phenotypically normal with normal secondary sexual characteristics. His blood tests show normal electrolytes, liver function, and fasting glucose levels. His T4 and TSH levels are within normal range, as is his prolactin level.
However, his testosterone level is low at 6.6 nmol/L (normal range is 9-30), while his LH and FSH levels are elevated at 23.7 mU/L (normal range is 4-8) and 18.1 mU/L (normal range is 4-10), respectively.
Which additional investigation would you choose to further evaluate this patient’s condition?
MRCP2-1492
A 57-year-old unemployed man presents to hospital with complaints of weight loss and weakness. He has difficulty climbing stairs and rising from his armchair at home. He lives alone and drinks 50 units of alcohol per week while smoking 20 cigarettes daily for 40 years. His blood pressure is 197/98 mmHg. Upon investigation, his Hb is 99 g/L, WBC is 9.8 ×109/L, platelets are 350 ×109/L, sodium is 145 mmol/L, potassium is 2.8 mmol/L, urea is 4.1 mmol/L, creatinine is 120 µmol/L, bicarbonate is 35 mmol/L, and glucose is 12.9 mmol/L. An arterial blood gas shows a pH of 7.26. Which investigation would be most useful in determining the cause of his illness?
MRCP2-1493
A 35-year-old female presents to the emergency department as a stand-by due to feeling unwell for the past 2 weeks. She reports experiencing lethargy, occasional shortness of breath, and light-headedness. Recently, she has also been experiencing urinary frequency and dysuria. Her general practitioner visited her at home 2 days ago and prescribed trimethoprim for a possible urinary tract infection.
Upon arrival, the patient appears pale and clammy, with cold peripheries. Her vital signs reveal oxygen saturations of 94% on air, a respiratory rate of 28/min, a heart rate of 117/min, and a blood pressure of 65/30 mmHg.
The patient has a medical history of type 1 diabetes, hypothyroidism, and uterine fibroids.
The patient is given intravenous fluids, and her blood pressure increases to 82/45 mmHg after receiving a total of 3 litres of fluids. She is started on intravenous amoxicillin and gentamicin.
What is the next step in managing this patient?
MRCP2-1494
A 65-year-old woman with a history of type 2 diabetes presents for a check-up. She has a mild cardiac failure that is being managed with ramipril and bisoprolol. Her current medication for diabetes is metformin 1g BD. During examination, her blood pressure is 122/82 mmHg, pulse is regular at 80 beats per minute. Bilateral basal crackles are heard on auscultation of the chest, and there is pitting oedema of both ankles. Her body mass index is elevated at 33 kg/m².
HbA1c 73 mmol/mol Creatinine 82 µmol/l
What is the most appropriate next step for managing glucose control?
MRCP2-1495
A 25-year-old woman with limited exposure to medical services presents to the Endocrinology Clinic. She has never had a period and previously felt this was due to having a short height, but she has recently decided to seek advice. On examination, she is significantly shorter than would be expected, given her parental height; her nipples are widely spaced and there is a suspicion of a high-arched palate. There appears to be a failure of secondary sexual characteristics. Her blood pressure is elevated at 149/90 mmHg. Investigations reveal a follicle-stimulating hormone (FSH) level of > 40 IU/l on at least two occasions. Given the likely diagnosis, what is the most likely complication in this patient?
MRCP2-1496
A 14-year-old boy presents with several months of muscle cramps and weakness all over his body. He also reports having an increased thirst and a strong desire for salty foods. He has no significant medical history.
During the examination, the boy appears to be in good health. His vital signs are as follows: Respiratory rate of 18/min Blood pressure of 116/78 mmHg Heart rate of 78/min
Blood tests are performed, and the results are as follows:
A urine dipstick test shows no glucose or protein present. A urine sample is sent to the lab for further analysis:
Urine calcium/creatinine ratio 0.05 (<0.14)
What is the most probable diagnosis?
MRCP2-1497
A 55-year-old obese HGV driver, who takes BD Novomix 30 insulin, visits your outpatient clinic seeking clarification on driving regulations he overheard while dining with colleagues. He is extremely anxious and tearful, fearing that his diabetes may cost him his livelihood.
The patient was diagnosed with type 2 diabetes 9 years ago and became insulin dependent 2 years ago. He reports good compliance with insulin every day. However, 18 months ago, he experienced dizziness after exercising and taking the same units of insulin. A spot blood glucose check revealed a reading of 2.8 mmol/l, which improved immediately after drinking Lucozade that he carried with him. He has no other medical history and no visual field or peripheral nerve impairments.
What advice would you give him regarding driving?
MRCP2-1498
A 63-year-old woman visits her doctor with complaints of hair loss, weight gain, and feeling lethargic. She reports no other health issues. The doctor orders thyroid function tests, and the results are:
What test is most likely to provide a definitive diagnosis?
MRCP2-1499
A 50-year-old man presents to the endocrinology clinic with abnormal blood test results. His GP had ordered thyroid function tests due to concerns about hair loss. The patient denies any other symptoms such as weight changes, temperature sensitivity, or mood changes. The GP suspected male-pattern hair loss but ordered the blood test anyway. The patient’s full blood count, renal function, and iron levels were all normal, but his TSH was 12mU/l and his free T4 was 12 pmol/l. On examination, there is no evidence of goitre.
What is the most appropriate management plan for this patient?