Archives: MRCP Part 2

MRCP2-1138

A 32-year-old woman with a history of previous injury in a car accident comes to the clinic with her husband. He looks after her as she has been left with a left arm and leg weakness after a head injury and intracranial bleeding. She also has migraines for which she takes sumatriptan. They complain that she is constantly thirsty and drinks several liters of water and juice each day. Her mother has significant chronic illness, suffering from chronic left ventricular failure.

Investigations:

Haemoglobin 120 g/l 120–160 g/l
White cell count (WCC) 6.2 × 109/l 4–11 × 109/l
Platelets 220 × 109/l 150–400 × 109/l
Sodium (Na+) 148 mmol/l 135–145 mmol/l
Potassium (K+) 4.2 mmol/l 3.5–5.0 mmol/l
Creatinine 130 µmol/l 50–120 µmol/l
Bicarbonate 24 mmol/l 24–30 mmol/l
Plasma osmolality 355 mosmol/kg 280–295 mosmol/kg
Urine osmolality 280 after water deprivation,
rises to 820 after DDAVP

What is the most likely diagnosis?

MRCP2-1101

A 68-year-old man comes to the Outpatient Clinic complaining of right iliac fossa abdominal pain and watery diarrhoea that has been going on for 10 months. He used to be a heavy drinker, consuming 40 pints of beer a week, but has cut back to 1 pint a day for several years. Lately, he has noticed that his symptoms worsen when he drinks alcohol, so he has stopped completely. His wife has noticed that he has lost weight recently, but he cannot say how much. He has never smoked, but his wife has observed some episodes of wheezing. During the abdominal examination, a 3 cm hepatomegaly and an indistinct mass in the right iliac fossa were found. Although urea and electrolytes, liver function tests, and full blood count were normal, a small-bowel barium examination revealed a submucosal mass in the ileum. What is the probable diagnosis?

MRCP2-1102

A 56-year-old woman presents to the cardiology clinic with echocardiogram results indicating cardiomyopathy. She was referred after experiencing shortness of breath and suspected heart failure. Her medical history includes hypertension, palpitations, and anxiety. Recently, she has been experiencing tremors, weight loss, sweating, and heat intolerance, and was diagnosed with hyperthyroidism and started on carbimazole. What is the anticipated prognosis for her cardiac condition?

MRCP2-1103

A 25-year-old man presents to the Clinic with a history of infertility. His GP had noted that the patient has gynaecomastia. He had a tonsillectomy at age 10, and had his appendix removed aged 18. Otherwise, he has no past history of note. She is not taking any regular medications.
On examination, he is overweight with acne and sparse hair growth on his face and body. His testicular volume is less than 5 ml.
Investigations reveal the following:
Investigations:
9 am testosterone 3 nmol/l 6-27 nmol/l
Luteinising hormone (LH) Elevated
Follicle stimulating-hormone (FSH) Elevated
What is the likely underlying diagnosis?

MRCP2-1104

A 49-year-old woman with no known medical conditions is diagnosed with thyroid cancer and undergoes a three-hour thyroidectomy. The day after the surgery, she reports experiencing tingling sensations in her hands and mouth, followed by a seizure that resolves on its own. Her ECG reveals a sinus rhythm with a QTc interval of 510 ms. Which abnormal test result is most likely responsible for her symptoms?

MRCP2-1105

A 40-year-old man has been admitted to the high dependency unit after undergoing surgery to remove a pituitary tumour. He is experiencing polyuria and dehydration 20 hours after the procedure. The following biochemistry results have been obtained:

– Urinary specific gravity: 1.004
– Urinary sodium: 40 mmol/L
– Urinary osmolality: 185 mOsm/kg
– Plasma sodium: 153 mmol/L
– Plasma osmolality: 309 mOsmol/kg

Based on these findings, what is the most likely diagnosis?

MRCP2-1106

A 30-year-old woman presents to the Emergency department with a severe viral upper respiratory tract infection. She has a history of type 1 diabetes for which she takes a basal bolus insulin regimen and a recent HbA1c was elevated at 66 mmol/mol.

On examination, her BP is 100/65 mmHg, pulse is 95 and regular, and she has a respiratory rate of 28. Her BMI is 21.

Investigations show:

Hb 124 g/L (115-160)

WCC 9.1 ×109/L (4-11)

PLT 189 ×109/L (150-400)

Na 137 mmol/L (135-146)

K 3.4 mmol/L (3.5-5.0)

Cr 129 µmol/L (79-118)

Bicarb 14 mmol/L (22-30)

pH 7.12 (7.35-7.45)

She is started on an insulin infusion and is rehydrated aggressively. Bloods are repeated two hours later.

Repeat investigations show:

Na 138 mmol/L (135-146)

K 4.0 mmol/L (3.5-5.0)

Cr 121 µmol/L (79-118)

Bicarbonate 19 mmol/L (22-30)

pH 7.25 (7.35-7.45)

The nursing staff have become very worried as she has become unconscious.

What is the most likely cause of her unconsciousness?

MRCP2-1107

A 42-year-old man visits the Diabetes Clinic. He was diagnosed with type II diabetes 2 years ago and has been taking metformin modified release 1 g twice a day, pioglitazone 30 mg once a day and gliclazide 80 mg once a day.
During examination, his HbA1c level is 80 mmol/mol (9.5%), and blood pressure (BP) is 140/80 mmHg. He has no microalbuminuria. Despite dietary advice and modification, he remains overweight, with a body mass index (BMI) of 32 kg/m2.
What is the most appropriate course of action for weight and glucose control?

MRCP2-1108

A 70-year-old male diabetic presents with weakness and lethargy. He has been diagnosed with type 2 diabetes mellitus for 10 years and is currently taking gliclazide, metformin, and atenolol for hypertension. On examination, there are no significant findings except for the following results: blood pressure of 160/90 mmHg while lying and standing, serum sodium of 135 mmol/L (137-144), non-haemolysed serum potassium of 5.7 mmol/L (3.5-5.5), urea of 8.3 mmol/L (2.5-7.5), serum creatinine of 141 µmol/L (60-110), plasma glucose of 10.1 mmol/L (3.0-6.0), and HbA1c of 62 mmol/mol (20-42) or 7.8% (3.8-6.4). He also has loss of pin prick and vibration sensation to the ankle in both legs and a background diabetic retinopathy. What could be the possible cause of these electrolyte abnormalities?

MRCP2-1109

A 20-year-old woman presents to the endocrine clinic with complaints of irregular periods, hirsutism, and weight gain. Her GP advised her to lose weight without offering any medication. She is currently studying medicine and takes no medication from the doctor. On examination, her blood pressure is 130/80 mmHg, pulse is 70 beats per minute and regular, and her body mass index is 31 kg/m². She has extensive hirsutism affecting the beard line, upper lip, and nipples, and acne over the face and upper chest. Relevant blood tests show a testosterone level of 4.5 nmol/l (upper limit of normal 2.0 nmol/l) and an LH:FSH ratio of 2.2. Her main concern is hirsutism.

What is the most appropriate intervention for this 20-year-old woman with hirsutism, irregular periods, and weight gain?