Archives: MRCP Part 2

MRCP2-1351

A 55-year-old woman is seen in your follow-up endocrinology clinic. She was referred by her GP a year ago after discovering a nodule in the front of her neck. Prior to this, she had experienced 6 months of worsening diarrhea and occasional flushing. She was diagnosed with a RET proto-oncogene mutation and underwent a thyroidectomy, followed by external beam radiotherapy. She is currently taking levothyroxine as her only medication.

What is the most effective test for monitoring the recurrence of this woman’s disease?

MRCP2-1352

A 23 year old woman has been experiencing mild to moderate abdominal pain on and off for over a year. She has also been feeling down and her periods have stopped. She has a history of two previous episodes of kidney stone formation that were treated without surgery. Recently, she was in a car accident and claims that the other car appeared out of nowhere. She has been having occasional severe headaches that have no specific features. When asked, she admits to noticing a white discharge from her nipple on occasion. She has had low blood pressure and has fainted several times in the past year. Her GP discovered low cortisol levels and started her on oral hydrocortisone before referring her to your clinic. During the examination, her blood pressure is 130/80. She has a red, blistering rash on her lower back and abdomen. Her abdomen is mostly non-tender and there is no palpable organ enlargement or peritonitis. Her visual fields are reduced bilaterally. Her urine dipstick shows glycosuria. The rest of the examination is unremarkable. What is the most effective treatment for the underlying condition?

MRCP2-1353

A 70-year-old man undergoes a laparotomy to correct a small bowel obstruction. He has a medical history of orthotopic bladder reconstruction due to bladder cancer. After 48 hours in the High Dependency Unit, he experiences confusion and refuses to consume oral fluids. His vital signs, including pulse rate, blood pressure, and urine output, are normal. The following serum biochemistry results are obtained:

– Na+ 147 mmol/L
– K+ 3.1 mmol/L
– Chloride 134 mmol/L
– Urea 14.3 mmol/L
– Creatinine 82 µmol/L
– Glucose 14 mmol/L

The patient is breathing air, and blood gas analysis reveals:

– pH 7.26
– PaCO2 2.57 kPa
– PaO2 9.92 kPa
– HCO3 16.3 mmol/L
– Base excess −14.6 mmol/L
– Lactate 1.6 mmol/L

What is the most appropriate initial intervention for this patient?

MRCP2-1354

A 32-year-old man of ethnic Indian descent presents to the endocrinology clinic for review of his type 1 diabetes. Despite being on a twice-daily mixed insulin regimen, he has poor diabetic control with elevated HbA1c and high blood glucose levels. He expresses concern about increasing his insulin dose or frequency due to his current overweight status with a BMI of 29 kg/m2. Are there any alternative medical management options available to improve his diabetic control besides increasing insulin?

MRCP2-1355

A 44-year-old man presents to his GP with an 8-week history of decreased libido, which is causing him distress. He has no recent illness or weight changes and denies any headaches or visual symptoms. On examination, his vital signs are normal, and there are no signs of liver disease. His testicular exam is unremarkable, and there is no scrotal swelling. However, he has a milky discharge from both nipples. What is the probable cause of this patient’s symptoms?

MRCP2-1356

A 35-year-old woman presents to the Endocrinology Clinic with fatigue and decreased sex drive. This is causing issues in her relationship. She has not had a period for the last 5 months. She takes no medication and works as a marketing manager. There is no history of deep vein thrombosis (DVT).
On examination, her BP is 118/72 mmHg, with pulse 68/min and regular. Her BMI is 25. Visual fields are normal.
Investigations:
Haemoglobin (Hb) 140 g/l 135 – 175 g/l
White cell count (WCC) 6.5 × 109/l 4.0 – 11.0 × 109/l
Platelets (PLT) 190 × 109/l 150 – 400 × 109/l
Sodium (Na+) 139 mmol/l 135 – 145 mmol/l
Potassium (K+) 4.2 mmol/l 3.5 – 5.0 mmol/l
Creatinine (Cr) 100 µmol/l 50 – 120 µmol/l
Prolactin 800 u/l 59 – 619 u/l
Pituitary MRI Normal
What is the best course of action for managing her symptoms?

MRCP2-1357

A 75-year-old male presents with exertional shortness of breath and palpitations. His symptoms developed over the last 24 hours.
Previously he was active but was diagnosed with angina two years ago for which he takes isosorbide mononitrate 60 mg daily, atorvastatin 10 mg daily, diltiazem 200 mg daily and aspirin 75 mg daily. Two months ago he presented to his GP with general apathy and was commenced on fluoxetine 20 mg daily.
On examination he was noted to have a heart rate of 122 beats per minute irregularly irregular, a blood pressure of 120/80 mmHg but otherwise appears fine. In particular he appeared clinically euthyroid and no goitre was palpable on examination. ECG confirmed atrial fibrillation.
Investigations reveal:
Serum free T4 26.5 pmol/L (10-22)
Serum free T3 4.8 pmol/L (5-10)
Serum TSH 0.1 mU/L (0.4-5.0)
Thyroid autoantibodies Negative –
ESR (Westergren) 28 mm/1st hr (0-10)
What could be the possible reason for his abnormal thyroid function tests?

MRCP2-1358

A 16-year-old girl presented with symptoms of anxiety and excessive sweating. Upon investigation, her TSH, Free T4, Total T4, Free T3, and Total T3 concentrations were measured. Which of the following diagnoses is compatible with her test results?

TSH concentration: 0.9 mU/L (0.5-3.4)
Free T4 concentration: 16 pmol/L (10-18)
Total T4 concentration: 180 nmol/L (55-145)
Free T3 concentration: 8.2 pmol/L (3.5-10.5)
Total T3 concentration: 3.3 nmol/L (0.9-2.5)

MRCP2-1359

A middle-aged couple visit their GP. They both have achondroplasia and are expecting their first child. They request a referral to a specialist Obstetric Clinic. What is the mode of inheritance for achondroplasia?