A 20-year-old woman with a history of type 1 diabetes presents to the Emergency department with symptoms of nausea and vomiting. She has a coeliac disease and follows a gluten-free diet. Her usual HbA1c is 53 mmol/mol. On examination, she appears dehydrated and tanned, which she attributes to spending time in the garden after her exams. Her blood pressure is 100/80 mmHg with a postural drop of 20 mmHg, and her pulse is 88 beats per minute and regular. Laboratory investigations reveal abnormal levels of Hb, Na+, K+, urea, creatinine, CRP, and eosin.
What is the most crucial intervention for managing this patient?
MRCP2-1307
A 67-year-old Muslim man with type II diabetes is currently taking metformin (500mg three times a day) and is planning to fast during Ramadan. He will have a light meal before sunrise (Suhoor) and a large meal at sunset (Iftar). As his endocrinologist, what advice would you give him regarding his metformin intake before the sunset meal?
MRCP2-1308
A 48-year-old woman with a history of paroxysmal atrial fibrillation undergoes a thyroidectomy for Graves’ disease. After several months, her symptoms recur, including palpitations from atrial fibrillation, and residual thyroid tissue is noted on postoperative scans. She is now scheduled for radioiodine therapy, but is admitted three days before the procedure with acute-onset abdominal pain. Although ischaemic colitis is suspected, an urgent CT scan of the abdomen with contrast rules out any acute pathology and she is discharged. What is the earliest possible time for her to receive the radioiodine therapy?
MRCP2-1309
A 16-year-old male is being seen at the endocrinology clinic for presenting with low serum testosterone and a lack of secondary sex characteristics. He has never fully developed pubertal body hair or muscle mass, and has small testicles. Additionally, he was born with a cleft palate and has difficulty with his sense of smell. What is the probable underlying diagnosis?
MRCP2-1310
A 18-year-old boy attends the clinic. He is concerned as she has not yet started puberty. He would like to be able to form relationships with girls but feels like he can’t at the moment. On examination, he is of average height and has absent secondary sexual hair, a small penis and testes. On further questioning, he reports occasional headaches and blurred vision. Investigations
Haemoglobin 130 g/l 120–160 g/l White cell count (WCC) 7.0 × 109/l 4–11 × 109/l Platelets 250 × 109/l 150–400 × 109/l Sodium (Na+) 142 mmol/l 135–145 mmol/l Potassium (K+) 4.2 mmol/l 3.5–5.0 mmol/l Creatinine 60 µmol/l 50–120 µmol/l Follicle-stimulating hormone (FSH) High Luteinizing hormone (LH) High Given the likely diagnosis, what appearance would you expect to see on pituitary magnetic resonance imaging (MRI)?
MRCP2-1311
A 25-year-old male has been referred by his doctor due to concerns about his sexual health. He has recently started a sexual relationship but is having difficulty achieving an erection and is worried about his poor sexual development. He reports that his pubertal development was also poor, with little pubic hair and embarrassment about his gonadal development. He works as a laborer on a building site, is physically active, and has no formal qualifications. He drinks 20 units of alcohol per week, mostly on weekends, and has one younger brother.
During examination, the patient appears phenotypically normal but is tall and lean with a BMI of 21.2 kg/m2. He has little beard growth, fine skin, and scanty body and pubic hair. His penile length is approximately 6 cm, and his testicular volumes are approximately 6-7 ml bilaterally (normal 10-15 ml). Cardiovascular, respiratory, and abdominal examination are all normal, and fundal examination and visual fields are normal as well.
Further investigations reveal a plasma testosterone concentration of 6.2 nmol/L (normal range 10-30), LH of 20.2 mU/L (normal range 2-10), FSH of 22.2 mU/L (normal range 2-10), prolactin of 433 mU/L (normal range 50-500), free T4 of 12.6 pmol/L (normal range 10-22), and TSH of 2.3 mU/L (normal range 0.4-5).
What is the likelihood of his brother developing this condition?
MRCP2-1312
A 45-year-old accountant presented to the medical assessment unit with a 2-month history of polyuria and elevated blood glucose levels. There was no family history of diabetes and she was not currently on any medication. On examination, her body mass index was 23 kg/m2 with normal general physical and systemic examination. Urine was negative for ketones.
What test may be useful in establishing the underlying diagnosis considering her clinical profile?
MRCP2-1313
A 70-year-old male was admitted with worsening shortness of breath and fever that had been getting worse over the past three days. He had been in good health prior to this, but had recently returned from a trip to Italy with his wife. He has a history of type 2 diabetes, which has been managed with diet alone for the past three years. He is also a smoker, consuming five cigarettes per day.
During the examination, the patient appeared slightly confused and had a tan. His oxygen saturation was 92% on room air. He had a fever of 40°C, a heart rate of 118 bpm, and a blood pressure of 118/90 mmHg. Crackles were heard in the left lower lung field upon auscultation.
What is the appropriate treatment for this patient’s hyponatremia?
MRCP2-1314
A 70-year-old male was admitted with worsening shortness of breath and fever that had been deteriorating over the past three days. He had been in good health prior to this and had recently returned from a trip to Italy with his wife. He has a history of hypertension and is a former smoker, having quit 10 years ago.
On examination, he appeared flushed and confused with oxygen saturation of 90% on room air. He had a temperature of 39°C, a heart rate of 110 bpm, and a blood pressure of 130/80 mmHg. Crackles were heard in the right lower lung field.
Which diagnostic test would be most helpful in determining the cause of the patient’s symptoms?
MRCP2-1315
A 43-year-old woman presents to your clinic. During a recent blood test ordered by her GP, it was noted that her TSH was < 0.1 mU/l. She has a history of thyroid cancer that has been surgically removed and is currently taking 100mcg of levothyroxine daily. She reports no other medical issues or symptoms. What is the recommended course of action?