Archives: MRCP Part 2

MRCP2-1401

A 25-year-old female presents with worsening acne and a marked increase in the development of body and facial hair which she finds very distressing. She is also overweight and is markedly stressed by her physical appearance and the development of stretch marks over her abdomen. She has tried multiple hair removal techniques with only mild success.

On examination, she has a body mass index of 28 kg/m², coarse hair over the anterior and posterior part of her chest and under her chin. Her Blood Pressure is 135/90 mmHg.

Her lab results are as follows:

9:00 am Cortisol 345 nmol/l (170 700 nmol/l)
LH 17 iU/l (1 20 iU/l)
Basal FSH 7.1 iU/l (1.0 8.8 iU/l)
DHEAS 545 µg/dl (31 228 µg/dl)
Prolactin 160 mU/l (<360 mU/l)
17 OH Progesterone 1025 ng/dl (<80 ng/dl)
Testosterone 3.9 nmol/l (0.9 3.1 nmol/l)

Ultrasound abdomen and pelvis reveals two cysts in the right ovary.

What is the most appropriate treatment option for her condition?

MRCP2-1402

A 25-year-old nursing student presents to the Emergency Medical Unit after experiencing a third episode of collapse in the past six months while on clinical rotation. She has a history of mild eczema and irregular menstrual cycles, which are currently being investigated. Her grandfather and uncle have been diagnosed with type II diabetes mellitus.

On examination, her blood pressure is 110/70 mmHg, heart rate is 75 bpm and regular, and oxygen saturation is 96% on room air. All other physical exams are unremarkable. Laboratory results show elevated C peptide levels and a glucose level of 2.1 mmol/l.

Based on this information, what is the most likely cause of her recurrent collapses?

MRCP2-1403

A 25-year-old female presents with complaints of sleepiness, weakness, and vivid dreams that have been occurring for the past two months. She has a history of type 1 diabetes for six years and has been using basal bolus insulin for the last six months. She adheres to a good diet and regularly monitors her blood sugar levels. She lives with two other female student colleagues and binge drinks often on Saturday nights.

On examination, she appears well with a BMI of 23 kg/m2, a pulse of 80 bpm, and a blood pressure of 112/70 mmHg. No abnormalities are noted. Her investigations reveal a haemoglobin level of 152 g/L, white cell count of 6.8 ×109/L, platelets of 280 ×109/L, serum sodium of 146 mmol/L, serum potassium of 3.9 mmol/L, serum urea of 5.5 mmol/L, serum creatinine of 88 µmol/L, plasma glucose of 7.9 mmol/L, and HbA1c of 6.2%.

What is the most likely cause of her symptoms?

MRCP2-1404

A 64-year-old man of South-Asian ancestry presents to the Cancer Assessment Unit due to chest pain after receiving his first cycle of carboplatin, pemetrexed and pembrolizumab for his recently diagnosed advanced metastatic adenocarcinoma of the lung. He has a past medical history of hypercholesterolaemia, hypertension, atrial fibrillation and chronic kidney disease stage 3. Despite reporting no trouble with the chemotherapy, he has reproducible pain on palpation of the chest wall and is discharged home with simple analgesia. However, a nursing colleague alerts the team to an unreadable high capillary blood glucose. Blood tests reveal hyperglycaemia with a glucose level of 28 mmol/l. What is the most likely cause for this patient’s hyperglycaemia?

MRCP2-1405

A 49-year-old woman presents to the Emergency Department (ED) after collapsing at home. She reports experiencing chest tightness, palpitations, and dyspnoea over the past two years, which have lasted for minutes at a time. In the last few months, she has also developed non-specific pins and needles in her extremities and ‘spots before her eyes’. She smokes 20 cigarettes a day and drinks alcohol socially. Her GP started her on a tricyclic antidepressant two weeks ago for depression. Her mother died of a stroke at age 48. On examination, she is restless, has a pulse of 108 bpm and regular, and a blood pressure (BP) of 180/70 mmHg. She has a 2/6 pansystolic murmur loudest at the apex. Investigations reveal abnormal levels of haemoglobin, platelets, potassium, glucose, and corrected calcium. What is the most likely diagnosis?

MRCP2-1406

A 45-year-old man presents to the Hypertension Clinic with a history of headaches and dizziness over the past four months. He also reports experiencing central abdominal discomfort and some recent weight loss, possibly due to a low-fat diet. On examination, his BP is 154/92 mmHg, and there is noticeable swelling in his thyroid. His bone profile shows a corrected calcium level of 2.76 mmol/l, and his GP has ruled out diabetes with a normal oral glucose tolerance test. What is the most likely cause of his hypertension?

MRCP2-1407

A 35-year-old man is brought to the Emergency Department (ED) by his family. He is convinced that his coworkers are plotting against him. His family reports that he has been sleeping very little and has been extremely agitated lately. He has no previous psychiatric history.
On examination, his blood pressure (BP) is 160/90 mmHg, with a pulse of 110 beats per minute (bpm) and no arrhythmia. Eye examination and thyroid palpation are normal.
Investigations reveal the following:

Haemoglobin (Hb) 140 g/l 130–170 g/l
White cell count (WCC) 6.2 × 109/l 4.0–11.0 × 109/l
Platelets (PLT) 200 × 109/l 150–400 × 109/l
Sodium (Na+) 142 mmol/l 135–145 mmol/l
Potassium (K+) 4.5 mmol/l 3.5–5.0 mmol/l
Creatinine (Cr) 80 μmol/l 50–120 µmol/l
Thyroid-stimulating hormone (TSH) 0.01 µU/l 0.17–3.2 µU/l
T4 28.5 pmol/l 11–22 pmol/l
Anti-thyroglobulin antibody +
What is the most likely diagnosis?

MRCP2-1408

A 35-year-old woman visits his primary care physician (PCP) complaining of fatigue. She is currently taking fluoxetine for postnatal depression, her child now being five months old. She has a past medical history of hypertension, which is well-controlled with medication. Her thyroid function tests reveal a TSH of 6.5 mU/l (normal range: 0.4-5.0 mU/l) and a free T4 of 9.5 pmol/l (normal range: 10-22 pmol/l). Anti-TPO antibodies are positive.
What is the most accurate prognosis for this patient?

MRCP2-1409

A 35-year-old female presents with complaints of tiredness and poor appetite. She gave birth to a healthy baby 3 months ago and is currently breastfeeding. During her pregnancy, she required iron for anaemia but is otherwise healthy and takes no medications. There is no significant family history. On examination, she has a BMI of 24 kg/m2, a pulse of 96 beats per minute, and a blood pressure of 124/70 mmHg. A small goitre is palpable, but no bruit is audible. She has a slight tremor of her outstretched hands. Cardiovascular, respiratory, and abdominal examinations are normal. Investigations reveal a haemoglobin level of 105 g/L (115-165), an ESR (Westergren) of 21 mm/1st hour (0-20), and abnormal thyroid function tests with elevated T4 and T3 levels and a low TSH level. What is the most likely diagnosis?

MRCP2-1410

A 46-year-old man is admitted to the psychiatric ward due to experiencing visual hallucinations for the past two days. He has a medical history of membranous glomerulonephritis and underwent a renal transplant last year. He is currently taking immunosuppressants.

Upon examination, there are no signs of focal neurology. The patient’s cranial nerves I to XII are normal, with reactive pupils that are equal in size. There are no cerebellar signs, but the plantars are equivocal on the left and downgoing on the right. The patient’s AMTS score is 8 out of 10. An urgent CT head scan shows no abnormalities.

Which medication could be a possible cause of the patient’s symptoms?