Archives: MRCP Part 2

MRCP2-1217

A 62-year-old man presents with recent blood test results. He has a medical history of hypertrophic cardiomyopathy, fibromyalgia, and haemorrhoids. He takes bisoprolol and disopyramide for his cardiomyopathy and is part of a graded exercise programme for his fibromyalgia. His blood results show an HbA1c of 49 mmol/mol (<42) and a fasting plasma glucose of 6.9mmol/L (3.9-5.4). Although he denies symptoms of polydipsia or polyuria, he reports feeling more fatigued than usual. What would be the most appropriate initial treatment regimen for him based on his blood results?

MRCP2-1218

A 32-year-old woman comes in for her first prenatal visit at 12 weeks gestation. She has a medical history of Hashimoto’s thyroiditis and is currently taking levothyroxine 100 mcg. Her recent blood work shows a TSH level of 1.0 mU/l.

What is the recommended course of action for managing her levothyroxine treatment now that she is pregnant?

MRCP2-1219

A 45-year-old man presents to his GP with a lump on the right side of his neck that has been present for 4 weeks. The lump measures approximately 7 mm and is located on the right side of the thyroid gland in the anterior triangle. The patient reports that the lump does not move when he sticks out his tongue, but it does move on swallowing. He denies any weight loss or night sweats.

Laboratory tests are ordered and reveal:

– Hemoglobin: 12.9 g/l
– Platelets: 210 * 109/l
– White blood cells: 6.0 * 109/l
– Sodium: 141 mmol/l
– Potassium: 3.9 mmol/l
– Urea: 4.1 mmol/l
– Creatinine: 33 µmol/l

What is the most appropriate initial investigation for this patient?

MRCP2-1220

A 34-year-old man and his wife have been struggling to conceive for the past decade. During his examination, you notice that he is tall and thin with bilateral gynaecomastia. Your colleague has conducted some initial tests, and one of them has come back indicating elevated levels of urinary gonadotrophins. What is the probable diagnosis?

MRCP2-1221

A 28-year-old female presented to the general medicine outpatient clinic after being referred by her GP due to feeling generally tired for the past few months. Her blood screen revealed no abnormalities except for a potassium level of 2.8 mmol/l. A repeat test four weeks later showed a level of 2.6 mmol/l, leading to the referral. She denied any other symptoms and had no past medical history or family history of note. Examination revealed a well 28-year-old lady with normal vital signs and unremarkable findings on cardiovascular, respiratory, gastrointestinal, and neurological systems. Further investigations revealed low potassium levels and high serum renin and aldosterone levels. What is the most likely diagnosis?

MRCP2-1222

A 65-year-old woman visits the diabetes clinic after experiencing a left Colles fracture. The healthcare provider suspects that she may have underlying osteoporosis. The patient is currently taking metformin, pioglitazone, BD mixed insulin, ramipril, indapamide, and amlodipine. During the examination, her blood pressure is 145/72 mmHg, pulse is 78 and regular, and BMI is 32. The following investigations were conducted: Hb 129 g/L (115-160), WCC 6.2 ×109/L (4-11), PLT 188 ×109/L (150-400), Na 137 mmol/L (135-146), K 4.9 mmol/L (3.5-5.0), Cr 123 µmol/L (79-118), and Ca 2.56 mmol/L (2.20-2.61). Which medication is most likely linked to the risk of osteoporotic fracture in this patient?

MRCP2-1223

A 28-year-old man with a 20-year history of type 1 diabetes and poor glycaemic control recently visited the clinic for a review. He is overweight, has abnormal LDL cholesterol, and is interested in trying liraglutide as an adjunct to his insulin therapy. During the examination, his BP was 155/92 mmHg, pulse was 72/min and regular, and his BMI was elevated at 32. A recent HbA1c test showed a reading of 66.1 mmol/mol (35 – 55 mmol/mol).

What benefits can the man expect from adding liraglutide to his current treatment plan?

MRCP2-1224

An 80-year-old man is referred to the diabetic clinic by his GP due to newly discovered hyperglycaemia. He reported a two-month history of polyuria, polydipsia, and diarrhoea, and his blood sugar was found to be 18.4 mmol/L. During this time, he lost 6kg and now weighs 61 kg. The patient has a medical history of hypertension and was diagnosed with deep vein thrombosis three months ago. He is currently taking amlodipine 10 mg and warfarin. What is the diagnosis?

MRCP2-1225

A 47-year-old man presents with feeling unwell. Upon further inquiry, he reports feeling fatigued and weak for the past few weeks. His wife has noticed that he has lost some weight, although he claims that his appetite has not decreased. He also mentions feeling more thirsty and having to use the restroom several times during the night. Recently, he has developed a rash around his groin area, which has now spread to his buttocks. Upon examination, there are patches of red with irregular borders and crusting.

A fasting blood test is conducted, revealing a blood glucose level of 9.2 mm/l. What is the next most appropriate investigation?

MRCP2-1226

A 65-year-old male presents with a 6 month history of nocturia. He is diagnosed with type 2 diabetes mellitus based on a fasting plasma glucose concentration of 10.1 mmol/L. His HbA1c is 58 mmol/mol (7.5%) and he has a BMI of 35.2 kg/m2.
What is the probable Beta cell mass in this patient?