Archives: MRCP Part 2

MRCP2-1297

A 25-year-old nursing student presents with frequent episodes of fainting. One of these occurred during a clinical placement in the Emergency Department while a patient was experiencing a heart attack. Blood glucose at the time was noted to be 1.6 mmol/l. All other blood tests were normal.
Upon examination immediately after an episode, her blood pressure was 120/80 mmHg, pulse was 90/min and regular, and she was clammy and cold. Blood taken at the time confirmed a venous blood glucose of 1.3 mmol/l, C-peptide level was low-normal, and insulin levels were significantly elevated.
What is the most probable diagnosis in this scenario?

MRCP2-1298

You are asked to see a 28-year-old woman who is 10 weeks into her first pregnancy. She has been experiencing frequent nausea and has lost weight as a result.
During the examination, she appears nervous. Her blood pressure is 110/75, with a pulse of 80 and regular. Her BMI is 21.
The following investigations were conducted:
s
Haemoglobin (Hb) 122 g/l 135 – 175 g/l
White cell count (WCC) 6.0 × 109/l 4.0 – 11.0 × 109/l
Platelets (PLT) 195 × 109/l 150 – 400 × 109/l
Sodium (Na+) 142 mmol/l 135 – 145 mmol/l
Potassium (K+) 3.6 mmol/l 3.5 – 5.0 mmol/l
Creatinine (Cr) 95 μmol/l 50 – 120 μmol/l
Glucose 5.0 mmol/l 3.9 – 7.1 mmol/l
Total Thyroxine (T4) 190 nmol/l 58 – 174 nmol/l
Thyroid-stimulating hormone (TSH) 0.8 mu/l 0.4 – 5.0 mu/l
What is the most appropriate course of action in this scenario?

MRCP2-1299

A 50-year-old male presents with impotence and diabetes. He was diagnosed with diabetes four years ago after experiencing erectile dysfunction. He reports complete impotence, a poor libido, and infrequent shaving. Despite trying sildenafil (Viagra), he has not had any success. His current medications include glibenclamide 10 mg daily, aspirin 75 mg daily, and amlodipine 5 mg daily for hypertension. On examination, he has normal secondary sexual characteristics, an irregular pulse of 80 bpm, a blood pressure of 126/86 mmHg, and a BMI of 24.4 kg/m2. Investigations reveal normal haemoglobin, white cell count, and platelets, but elevated liver enzymes and low testosterone levels. Which of the following is the most appropriate investigation for this patient?

MRCP2-1300

A 35-year-old man presents to the hypertension clinic with daily headaches for the past 3 months. He reports feeling otherwise well. On examination, his blood pressure is 165/90 mmHg, heart rate is 80 beats per minute, temperature is 37.2 ºC, and SpO2 is 96% on air. Notably, he has pronounced lower jaw protrusion with increased interdental spaces. Laboratory results show a hemoglobin level of 145 g/L, platelets of 225 * 109/L, WBC of 8.2 * 109/L, Na+ of 138 mmol/L, K+ of 3.8 mmol/L, urea of 5.4 mmol/L, and creatinine of 66 µmol/L. His random glucose level is 14.5 mmol/L. What is the initial investigation that should be performed?

MRCP2-1270

A 28-year-old woman has been referred to the Endocrinology clinic after discovering she is pregnant. She was diagnosed with hypothyroidism two years ago and is currently stable on a dose of levothyroxine 75 mcg once daily. She has also been taking folic acid 400 mcg once daily for the past 6 months. Her last blood test taken 6 months ago showed a TSH level of 1.4 mU/l.

You decide to order a repeat TSH and free T4 measurement. What is the most appropriate next step?

MRCP2-1271

A 50-year-old man visits the endocrine clinic for assessment. He has experienced a weight gain of 3 stones in the last 6 months, and his general practitioner is concerned about the possibility of Cushing’s syndrome. An initial 24-hour urinary free cortisol test has been conducted, which shows elevated levels. The patient has hypertension, with a blood pressure reading of 155/90 mmHg, and his pulse is regular at 75 beats per minute. He has a body mass index of 35 kg/m² and noticeable abdominal striae. Which of the following findings would be most indicative of an adrenal adenoma that produces cortisol?

MRCP2-1272

A 26-year-old nurse presents after collapsing on a night shift. His blood glucose is measured at being 1.4 mmol/l. His blood pressure at the time was noted to be 115/82 mmHg. He has no palpitations and had not bitten his tongue or become incontinent during the episodes. He was shaken afterwards, although did not have memory loss and stated he had not tripped over anything. He also said he has had five of these episodes over the last two weeks.

Blood tests are sent off and unremarkable except for a low-normal C-peptide level and markedly raised insulin level.

What is the most likely diagnosis for the multiple episodes of collapse in this 26-year-old nurse?

MRCP2-1273

A 72-year-old man with advanced prostate cancer and bone metastases is admitted to the hospital, complaining of generalised abdominal pain and presenting with some confusion. Various blood tests are conducted, including the following:

Calcium 3.2 mmol/L (2.1-2.6)

Despite aggressive intravenous fluid rehydration (4-6 litres per day) and the administration of Pamidronic acid, the treatment proves to be ineffective. A repeat blood test shows a similar result:

Calcium 3.18 mmol/L (2.1-2.6)

What would be the most reasonable next step to take?

MRCP2-1274

A 67-year-old man with a history of bladder cancer, hypertension, and chronic kidney disease presents to his GP with symptoms of polyuria and polydipsia. His current medications include amlodipine, furosemide, atenolol, and ramipril. Upon examination, there are no notable findings. Laboratory results reveal elevated levels of urea and creatinine, as well as a decreased eGFR. The patient’s HbA1c is also elevated. What medication would be the most appropriate to initiate?

MRCP2-1275

A 75-year-old woman presents to the chronic kidney disease clinic with a history of hypertension. She is currently taking amlodipine 5mg od and ramipril 10mg od. Her recent laboratory results show:

Blood pressure today is 128/74 mmHg.

Recent 12 months ago
Na+ 140 mmol/l 141 mmol/l
K+ 4.5 mmol/l 4.3 mmol/l
Urea 11.2 mmol/l 10.5 mmol/l
Creatinine 124 µmol/l 114 µmol/l
eGFR 39 ml/min 43 ml/min

What would be the most appropriate course of action for her management?