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?

MRCP2-1110

A 35-year-old woman with type II diabetes complains of frequent urinary tract infections (UTIs) despite multiple courses of antibiotics, including trimethoprim and amoxicillin. She reports dysuria and discomfort in her groin area. Her recent Hba1c was 100 mmol/mol (11.3%). An abdominal ultrasound showed no signs of pyelonephritis or structural abnormalities. What is the probable pathogen responsible for her UTIs?

MRCP2-1111

A 35-year-old man is being seen in clinic for follow-up. He has a history of multiple previous fractures and early onset of puberty.
During the examination, he presents with café-au-lait skin pigmentation. His pulse rate is 100 beats/min and regular, and he has sweaty palms. His thyroid function tests reveal an elevated fT4 at 23.4 pmol/l and a low TSH at 0.09 mIU/l. His bone profile (calcium, phosphate, ALP, PTH, and Vitamin D) is within normal limits.
What is the most likely diagnosis?

MRCP2-1112

A 10-year-old boy is referred to the department of paediatrics by his general practitioner. He has developed secondary sexual characteristics at the age of 8. He has no significant past medical history and does not take any regular medications. His father commenced puberty at 10 years of age.

On examination, he has a coarse voice and facial hair. His testicles have enlarged. There is acne and adult body odour. The neurological examination is unremarkable. His blood pressure was 155/88 mmHg. There is no rash.

Blood tests:

Hb 136 g/L Male: (135-180)
Female: (115 – 160)
Platelets 388 * 109/L (150 – 400)
WBC 4.2 * 109/L (4.0 – 11.0)
Na+ 138 mmol/L (135 – 145)
K+ 2.9 mmol/L (3.5 – 5.0)
Urea 4.2 mmol/L (2.0 – 7.0)
Creatinine 66 µmol/L (55 – 120)
CRP 4 mg/L (< 5)
Testosterone 42 ng/dl (7-20)
FSH 1.2 IU/L (<3)
LH 1.1 IU/L (0.02-4.8)
TSH 1.2 mIU/L (0.5-5.5)

What is the most likely diagnosis based on the given information?

MRCP2-1113

A 65-year-old patient with type 1 diabetes presents with hypertension. His blood pressure in clinic is 210/110 mmHg despite treatment with bendroflumethiazide, atenolol and doxazosin.

Investigations demonstrate the following:

Na 136 mmol/L (135-145)

K 3.5 mmol/L (3.5-5.0)

Urea 8.9 mmol/L (3.0-8.0)

Creatinine 132 µmol/L (70-120)

Urinary metanephrines Mets 700 nmol/24 hr (<2000) Normets 3277 nmol/24 hour (<4900) Urinary free cortisol 250 nmol/L (<248) Plasma renin <0.05 mU/L (5.4-60 upright) (5.4-30 after 1 hour rest) Aldosterone 1258 pmol/L (100-450 adults overnight) (100-800 random sample/upright) What is the most likely cause of hypertension in this patient?

MRCP2-1114

A 56-year-old woman with a six year history of type 2 diabetes presents to the Emergency Department with symptoms of central crushing chest pain, sweating, and pre-syncope. She is currently taking metformin 1 g BD for diabetes and amlodipine and valsartan for hypertension. On examination, her BP is 130/70, pulse is 85 and regular, and heart sounds are normal. Investigations reveal an HbA1c of 53 mmol/mol and a hsTroponin level of 1.2 (<0.05). What is the most appropriate way to manage her blood glucose control? Hb 137 g/l (115-160) WCC 7.0×10(9)/l (3.8-10.8) PLT 199×10(9)/l (150-450) Na 140 mmol/l (135-145) K 5.0 mmol/l (3.5-5.5) Bicarbonate 23 mmol/l (18-28) Cr 105 micromol/l (50-90) ECG Sinus rhythm, anterior T wave inversion

MRCP2-1115

A 16-year-old boy presents to the Emergency Department with polyuria, polydipsia, and chronic headaches. He also reports experiencing some vision difficulties recently. He has no significant medical history.

Upon examination, the patient appears healthy with a blood pressure of 136/78, pulse of 82 bpm, and temperature of 36.9°C. Pupils were equal and reactive to light and accommodation, and fundoscopy did not reveal any abnormalities.

Lab results showed:
– Haemoglobin: 132 g/L (130-180)
– White cell count: 7.9 ×109/L (4-11)
– Platelets: 290 ×109/L (150-400)
– Serum sodium: 150 /L (137-144)
– Serum potassium: 4.2 /L (3.5-5.0)
– Serum urea: 4.8 /L (2.5-7.5)
– Serum creatinine: 68 Umol/L (60-110)
– Fasting plasma glucose: 5.5 mmol/L (3-6)
Urinalysis results are pending.

What is the most likely visual field defect in this case?

MRCP2-1116

A 64-year-old woman presents to the Endocrine Clinic with hypercalcaemia and hypophosphataemia. She reports feeling tired and thirsty lately. On examination, her blood pressure is 122/72 mmHg, pulse is 70 bpm and regular, and BMI is 23 kg/m2. Primary hyperparathyroidism is suspected. When should surgical referral be considered?

MRCP2-1117

A 55-year-old male presents with weight loss and agitation. Upon examination, a fine tremor, goitre, and tachycardia are observed. Further investigations confirm thyrotoxicosis with positive TSH receptor autoantibodies. The patient decides to undergo radioactive iodine treatment. What is the correct statement regarding therapy for this patient?

MRCP2-1118

A 42-year-old woman presents to the endocrinology clinic with a 6-week history of weight gain and fatigue. Her vital signs are stable, but her blood pressure is elevated. Laboratory tests reveal hyperglycemia and a low-dose dexamethasone suppression test shows elevated cortisol levels. What is the recommended next step in her evaluation?