Archives: MRCP Part 2

MRCP2-1227

A 30-year-old woman presents to the endocrinology clinic with a complaint of unintentional weight loss of 5kg. She denies any changes in her diet or exercise routine but reports feeling warmer, having trouble sleeping, and experiencing a slight tremor in her hands. Her medical history is significant for depression, which is managed with sertraline. Physical examination reveals a BMI of 24 kg/m², a resting tremor, and a large non-tender goiter without palpable nodules or lymphadenopathy. Laboratory tests show an undetectable TSH and a free T4 level of 39 pmol/l, confirming a diagnosis of hyperthyroidism. What is the most appropriate next step in determining the type of hyperthyroidism in this patient?

MRCP2-1228

What traits are indicative of adult growth hormone (GH) deficiency?

MRCP2-1229

A 35-year-old woman has been referred to you for management of her obesity.

When considering treatment options for this patient, it is important to take into account her medical history, current lifestyle habits, and any underlying conditions that may be contributing to her weight gain. A comprehensive approach to weight loss may include dietary modifications, increased physical activity, behavioral therapy, and possibly medication or surgery. It is important to work with the patient to develop a personalized plan that is sustainable and achievable for her individual needs and goals. Regular follow-up and support can also be crucial for long-term success in managing obesity.

MRCP2-1230

A 65-year-old female who is a retired teacher presents to the Emergency department with sudden difficulty breathing after a long flight. She has not experienced any other health issues recently.
During the examination, her pulse is found to be 98 bpm, her oxygen saturation is 92% on air, and her blood pressure is 120/80 mmHg. Her legs and chest appear normal.
The medical team suspects a pulmonary embolism and starts her on IV heparin therapy. A VQ scan confirms the diagnosis.
Despite not showing any signs of thyrotoxicosis, the doctors perform thyroid function tests due to her previous occupation. The results show:
TSH 1.5 mU/L (0.35-5.0)
free T4 44.2 pmol/L (9.8-21.2)
free T3 6.5 pmol/L (3.5-6.8)
What is the probable cause of the abnormal thyroid function tests in this patient?

MRCP2-1231

A 55-year-old male patient undergoes blood tests and the results are as follows:

LH: 1 U/L (normal range: 1.3-8.4)
FSH: <1 U/L (normal range: 2.9-8.4)
Testosterone: 7.5 nmol/L (normal range: 10-28)

What is the probable diagnosis?

MRCP2-1232

A 45-year-old woman presents with a one-year history of tiredness, weight gain, and fatigue. She had undergone trans-sphenoidal resection of a non-functioning pituitary tumor two years ago, which resulted in pan-hypopituitarism. Currently, she is being treated with hydrocortisone, thyroxine, and oral contraceptive Logynon. On examination, her blood pressure is 110/64 mmHg, and her pulse is 80 bpm. Her free T4 level is 12.5 pmol/L, plasma TSH is 0.2 mU/L, and serum estradiol is <80 pmol/L. What is the most appropriate treatment for her fatigue?

MRCP2-1201

A 50-year-old man presents to the Endocrinology Clinic for evaluation. His GP referred him due to a gradually enlarging mass in the left lobe of the thyroid. The patient is worried about the possibility of having cancer. What factors could potentially increase the probability of thyroid malignancy in this individual?

MRCP2-1202

A 47-year-old woman presents to the endocrinology outpatient service with incidental hypercalcaemia on a routine blood test. She has no significant medical history.

On examination, there are no notable findings.

Lab results:

– Parathyroid hormone: 8.2 pmol/L (normal range: 1.6 – 6.9)
– Calcium: 2.78 mmol/L (normal range: 2.20-2.6)
– Vitamin D: 72 nmol/L (normal range: >50)
– Urea: 4.5 mmol/L (normal range: 2.0 – 7.0)
– Creatinine: 70 µmol/L (normal range: 55 – 120)

What is the most likely cause of these findings?

MRCP2-1203

A 57-year-old female patient presents to you with a complaint of tiredness that has been ongoing for three years. During the examination, you find an elevated calcium concentration in her blood. She has been feeling depressed since the death of her elderly parents. Her elder brother and his son were diagnosed with a calcium problem six years ago, but they have not received any treatment. She takes only atenolol for hypertension and does not take any supplements. Her blood pressure is 148/96 mmHg, and no other abnormalities are noted during the examination.

The following investigations were conducted:
– Serum sodium: 138 mmol/L (137-144)
– Serum potassium: 3.8 mmol/L (3.5-4.9)
– Serum urea: 7.1 mmol/L (2.5-7.5)
– Serum calcium: 2.76 mmol/L (2.2-2.6)
– Serum phosphate: 1.0 mmol/L (0.8-1.4)
– Alkaline phosphatase: 100 U/L (45-105)
– PTH concentration: 4.4 pmol/L (0.9-5.4)
– Urine calcium: 1.2 mmol/24 hrs (2-10)

What treatment plan would you recommend for this patient?

MRCP2-1204

A 50-year-old woman was incidentally found to have hypercalcemia. She presented with no symptoms and had a normal physical examination. Further investigations revealed the following results:

– Serum sodium: 138 mmol/L (137-144)
– Serum potassium: 4.1 mmol/L (3.5-4.9)
– Serum urea: 3.8 mmol/L (2.5-7.5)
– Serum creatinine: 88 µmol/L (60-110)
– Serum corrected calcium: 2.76 mmol/L (2.2-2.6)
– Serum phosphate: 0.86 mmol/L (0.8-1.4)
– Serum alkaline phosphatase: 86 U/L (45-105)
– Plasma parathyroid hormone: 5.3 pmol/L (0.9-5.4)
– 24-h urinary calcium: 0.5 mmol/24hr (2.5-7.5)

What is the most likely diagnosis?