MRCP2-1360

A 17-year-old woman presents to her primary care physician with recurrent episodes of vaginal thrush. She has no other significant symptoms indicating hyperglycemia. A strong family history of type 2 diabetes is noted and the physician arranges to check fasting plasma glucose. Two samples are checked and the laboratory glucose results are 8.1 and 8.2 mmol/l. Urine is negative for ketones. HbA1C, also checked by the physician, is elevated at 74 mmol.mol (8.9%). Her BMI is 23 and her BP is 110/75.
What is the most appropriate initial treatment for this patient?

MRCP2-1361

You are assessing an elderly gentleman with type 2 diabetes. He is currently taking metformin and a once daily long-acting insulin analogue at night. He regularly monitors his blood sugar levels in the morning and has recently contacted the clinic due to experiencing some low readings. In the past 1-2 weeks, he has had three readings between 3.0 and 4.0 mmol/L. He is currently on a nightly dose of 40 units of insulin. What is the most appropriate advice to give regarding his insulin dosage?

MRCP2-1362

A 30-year-old woman with a past medical history of infertility and severe reflux symptoms came to the clinic with a high calcium level of 2.80 mmol/l. Upon testing, her PTH levels were found to be elevated. What is the diagnosis?

MRCP2-1363

A 25-year-old female patient visits the clinic with asymptomatic hypercalcemia. She reports experiencing intermittent indigestion and a loss of libido, but no other notable symptoms. During the examination, her blood pressure is 124/72 mmHg, pulse is 78 and regular, and her BMI is 22. Respiratory and abdominal examinations reveal no abnormalities. The following are the results of her investigations:

– Haemoglobin: 120 g/L (11.5-16.0)
– White cell count: 7.0 ×109/L (4-11)
– Platelets: 228 ×109/L (150-400)
– Sodium: 138 mmol/L (135-146)
– Potassium: 3.9 mmol/L (3.5-5)
– Creatinine: 113 µmol/L (79-118)
– Calcium: 2.94 mmol/L (2.21-2.60)
– Prolactin: 1350 mU/L (<520) Which type of pancreatic tumor is most likely to be present in this patient?

MRCP2-1364

A 28-year-old female patient presents with symptoms of headaches, sweating, anxiety, and palpitations. She reports a family history of similar symptoms on her father’s side, which required surgery. Additionally, she complains of constipation and polydipsia. During examination, her blood pressure is elevated at 160/95. Two 24-hour urinary collections for catecholamines were above the upper limit of normal, and her bone profile shows elevated corrected calcium and parathyroid hormone levels. The physician recommends genetic testing to diagnose which condition?

MRCP2-1365

A 32-year-old male presents with hypertension, anxiety attacks, and palpitations. Upon screening for secondary hypertension, he consistently shows high urinary catecholamine concentrations. He is a part-time smoker, smoking 10 cigarettes per week, and drinks approximately 18 units of alcohol weekly. He has no significant medical history and is adopted, so no family history is available. He is referred to the local endocrine department where a CT scan of his abdomen reveals bilateral adrenal masses of 4 cm diameter. Additionally, an elevated plasma calcitonin concentration is noted. What other abnormality is likely to be present in this patient?

MRCP2-1366

A 27-year-old male presents with hypertension, agitation, and sweats that have been ongoing for six months. He has no significant family history, smoked 10 cigarettes per day, and drinks minimally. His current medications for hypertension include bendroflumethiazide 2.5 mg/d and ramipril 10 mg per day. On examination, his blood pressure is 176/94 mmHg, and his BMI is 23.5 kg/m2. Further investigations reveal a urine free metadrenaline level of 12 µmol/24 hr (<5) and a fasting plasma calcitonin level of 100 ng/L (0-11.5). An MRI scan of the abdomen shows a 3.5 cm mass in the right adrenal gland. What other diagnosis is likely to be associated with his condition?

MRCP2-1367

An 80-year-old woman is admitted to the emergency department with hypothermia, sinus bradycardia, and unresponsiveness. A CT scan of the head shows no acute Intracranial issues. The patient is given passive warming and intravenous fluids. Blood tests are conducted, revealing the following results. Family members report that the patient has been experiencing symptoms of lethargy, cold intolerance, and weight gain over the past few months.

TSH >30.0 mU/L
T3 <0.05 mU/L What is the most appropriate initial treatment for this patient?

MRCP2-1368

A 75-year-old female presents to the Emergency Department in a state of acute illness after being discovered unresponsive on the floor of her home by her daughter. She has a history of hypothyroidism and takes thyroxine daily, but her adherence to treatment is uncertain. On examination, she is unresponsive with a Glasgow Coma Scale score of 6/15, a central temperature of 34°C, oxygen saturations of 95% on air, a pulse of 44 beats per minute, and a blood pressure of 100/80 mmHg. There are no focal neurological signs, but both plantar reflexes are extensor. What is the most appropriate immediate treatment for this patient before the results of her emergency blood tests are available?

MRCP2-1369

A 75-year-old man is brought to the hospital by his family after being found unresponsive. Upon examination, the patient has a GCS of 8 and is overweight with a yellowish tint to his skin. His pulse is 50 beats per minute and his temperature is 35°C. The patient’s heart sounds are normal, but the ECG shows a rate of 49 bpm. Coarse crepitations are heard upon auscultation of the chest, and there is generally decreased air entry bilaterally. What is the most likely diagnosis?