Archives: MRCP Part 2

MRCP2-1195

A 32-year-old woman with a history of Graves’ disease presents to the endocrinology clinic for follow-up. She underwent radioiodine treatment a year ago and has since remained clinically and biochemically euthyroid. Her initial symptoms of weight loss and insomnia have not recurred. Her GP ordered blood tests prior to the appointment, which revealed a TSH level of 2.6 and a free T4 level of 8.2mg/dl. The patient has recently discontinued oral contraceptive use and is planning to conceive. What is the most appropriate management plan?

MRCP2-1196

You are requested to assess a 63 year-old Caucasian man who is currently admitted to the medical admissions unit for treatment of a community acquired pneumonia affecting his left lower lobe. Prior to admission, he had a history of excessive alcohol consumption but has been abstinent for the past four days.

During his hospital stay, the patient’s blood glucose levels have been consistently elevated, leading to a new diagnosis of type two diabetes. Additionally, the admission consultant noted the presence of Cushingoid features and ordered an overnight low dose dexamethasone suppression test. The results of the test are as follows:

– 8am Cortisol after 1 mg dexamethasone at 11pm the previous day: 438 nmol/L
– Reference range for serum cortisol: 170-540 nmol/L

What would be the most appropriate next step in investigating this patient’s condition?

MRCP2-1197

A 55-year-old truck driver has been referred to secondary care for poorly controlled type 2 diabetes mellitus. Despite being diagnosed six years ago, he has not made any lifestyle changes and now has diabetic nephropathy and proliferative retinopathy. He also has a history of ischaemic heart disease, hypertension, hypercholesterolaemia, osteoarthritis, and gout. His current medications include aspirin, ramipril, simvastatin, naproxen, co-codamol, lansoprazole, metformin, gliclazide, and pioglitazone. He smokes 20 cigarettes per day and drinks 15 units of alcohol per week. On examination, he is obese with a BMI of 38 kg/m and has a blood pressure of 148/88 mmHg. His investigations reveal elevated levels of urea, creatinine, and HbA1c. What is the most appropriate management step for this patient?

MRCP2-1198

A 32-year-old woman with no prior medical history visits her GP complaining of feeling anxious and on edge for the past month. She also experiences sweating and hand tremors that are affecting her work as a teacher. She occasionally experiences abdominal bloating, which she manages with herbal tea.

During the examination, the patient appears flushed and tremulous but alert. There is no goitre or skin rash present. A small non-tender mass is palpable on the left side of her pelvis, with normal bowel sounds overlying. Her visual fields and cranial nerve exams are normal. A thyroid scintigraphy shows normal uptake, and an MRI scan is pending.

TSH levels are 5.0 mU/L (range 0.4-4.0), and T4 levels are 28 pmol/l (range 9-24). Urine HCG is negative. What is the most likely diagnosis?

MRCP2-1199

A 28-year-old woman presents to the endocrine clinic as an urgent referral from her GP. She has been experiencing flu-like symptoms and pain in the front of her neck, and is now extremely agitated and anxious. Her husband reports that she is having difficulty sleeping due to worry about a potential serious condition. She is currently taking the combined oral contraceptive pill.

During examination, her blood pressure is 145/82 mmHg, pulse is 95 and regular, and she has a fine tremor with slightly sweaty hands. Heart sounds are normal, her chest is clear, her abdomen is soft and non-tender, and her BMI is 22. She experiences tenderness over the thyroid during palpation of the neck.

Investigations reveal a haemoglobin level of 119 g/L (115 – 160), white cell count of 9.3 ×109/L (4 – 11), platelets of 198 ×109/L (150 – 400), sodium of 139 mmol/L (135 – 146), potassium of 4.0 mmol/L (3.5 – 5), and creatinine of 100 µmol/L (79 – 118). Her TSH level is 0.2 IU (0.5 – 5).

What is the most appropriate treatment for her symptoms?

MRCP2-1200

A 35-year-old female patient presents to her GP requesting a cholesterol check. She has a medical history of endometriosis and controlled type 2 diabetes through diet. She drinks a glass of red wine every evening and exercises regularly. She is currently taking oral contraceptives.
The results of her tests are as follows:
Test Result Normal Range
LDL cholesterol 4.8 mmol/l < 3.5 mmol/l
Triglycerides 1.9 mmol/l 0–1.5 mmol/l
HDL cholesterol 0.7 mmol/l > 1.0 mmol/l
What is the most likely reason for the patient’s low HDL cholesterol levels?

MRCP2-1178

A 38-year-old teacher is discovered collapsed outside her home. Upon arrival at the Emergency department, her blood glucose level is measured at 1.9 mmol/L. What immediate investigations should be conducted?

MRCP2-1179

A 20-year-old man presents to the endocrinology clinic for follow-up. He was previously managed in the paediatric clinic for congenital hypoparathyroidism and is currently receiving vitamin D and calcium supplements. He has a history of one episode of renal stones in the past 2 years and his creatinine level is elevated at 125 micromol/l. What is the optimal target for his serum calcium level?

MRCP2-1180

You are evaluating a 55 year-old man in the diabetes clinic who has type 2 diabetes mellitus. He is presently on a regimen of metformin 850mg thrice daily and gliclazide 80mg once daily.

Upon further inquiry, he confesses to experiencing frequent hypoglycemic episodes at night that cause him distress as he lives alone. He has a BMI of 30.3 kg/m², HbA1c of 7.8% (62 mmol/mol), and co-morbidities that include congestive cardiac failure.

What modifications would you make to his diabetic therapy?

MRCP2-1181

A 35-year-old man presents to the ischaemic heart disease clinic after experiencing an inferior myocardial infarction. He has been diagnosed with heterozygous familial hypercholesterolaemia and prescribed 80 mg per day of atorvastatin. Despite this, his LDL cholesterol remains at 3.5 mmol/l. What is the most suitable course of action to take next?