Archives: MRCP Part 2

MRCP2-1085

A 36-year-old woman presents to the outpatient department with complaints of pain in her calves when walking 50 meters. She has no significant medical history except for a history of migraines. Her family history includes her mother having diabetes and her father dying of a heart attack at the age of 46. She is a heavy smoker, smoking 35 cigarettes per day, and drinks a glass of wine every evening. She works as a financial advisor.

During the examination, the physician observes tendon xanthomas affecting the extensor tendons of her fingers. Additionally, xanthelasma is noticed around both eyes and corneal arcs.

What is the most likely diagnosis?

MRCP2-1086

A 45-year-old female presented to Endocrinology Clinic with a 4-month history of weight gain, fatigue and headaches. Over the last 4 weeks, she has also experienced galactorrhoea and reduced libido. She was diagnosed with type 2 diabetes and hypertension 2 months ago and is on diet control for both. She is not currently on any regular medications.

During examination, there was evidence of hirsutism and acne, a cervical fat pad, striae on her abdomen and proximal myopathy. Areas of hyperpigmentation were noted on her mucous membrane and palmar creases.

Which of the following investigations will reveal the diagnosis?

MRCP2-1087

A 23 year-old man presents with a six week history of increasing thirst and frequency of urinating. The GP suspects diabetes and performs two fasting blood tests on separate days which reveal blood glucose results of 8.9 mmol/l and 9.5 mmol/l. Urinalysis does not detect any ketones or protein in the urine. The patient’s mother had a diagnosis as type 1 diabetes at the age of 21 and his maternal grandfather and aunt also have type 1 diabetes. Due to the family history, the patient’s c-peptide is measured and found to be consistently high on two occasions.

What would be the most appropriate initial treatment for managing this condition, given the likely diagnosis?

MRCP2-1049

A 35-year-old woman comes to the clinic with concerns about her sexual health. She reports experiencing vaginal dryness during intercourse and has noticed that her breasts leak milk with minimal stimulation. She also mentions that she has not had a period in the past 6 months. Her medical history includes recent use of metoclopramide for nausea. On examination, her blood pressure is 140/80 mmHg, pulse is 80/min and regular. She has some peripheral field visual loss. Laboratory results show elevated prolactin levels and abnormal thyroid function tests. Which of the following is the most likely diagnosis?

MRCP2-1050

A 56-year-old man presented to endocrine clinic with gradually worsening low mood, malaise, and reduced exercise capacity. He had a history of non-functioning pituitary adenoma (NFPA) surgery resulting in partial anterior hypopituitarism and was on thyroxine and hydrocortisone replacement therapy. He had central adiposity and a medical history of dyslipidaemia, epilepsy, and ischaemic heart disease (IHD). Due to his medical history, an insulin tolerance test was contraindicated.

The following investigations were conducted: 9am cortisol 415 nmol/l, IGF-1 8 nmol/l (16 – 118), FT4 15.4nmol/l (11.5 – 22.7), and TSH 0.03mU/l (0.35 – 5.5).

What is the most appropriate test to confirm the diagnosis of adult GH deficiency in this case?

MRCP2-1051

A 32-year-old woman comes to the clinic with a complaint of a lump at the base of her neck. She has noticed that it has become more noticeable when she swallows and has grown significantly over the past 8 weeks. She also reports experiencing diarrhea for the past few months. During the clinical examination, a thyroid nodule is discovered. Further questioning reveals that her aunt had a thyroidectomy due to cancer. The following investigations were conducted:

s
Haemoglobin (Hb) 130 g/l 135 – 175 g/l
White cell count (WCC) 6.2 × 109/l 4.0 – 11.0 × 109/l
Platelets (PLT) 250 × 109/l 150 – 400 × 109/l
Sodium (Na+) 142 mmol/l 135 – 145 mmol/l
Potassium (K+) 4.8 mmol/l 3.5 – 5.0 mmol/l
Creatinine (Cr) 100 μmol/l 50 – 120 μmol/l
Corrected calcium (Ca2+) 2.75 mmol/l 2.2 – 2.7 mmol/l
Ret oncogene positive

What is the most likely diagnosis in this case?

MRCP2-1052

A 28-year-old woman presents to her general practitioner with complaints of fatigue. She is 28 weeks pregnant with her first child. She has no past medical history and is not taking any medications.

Upon examination, her abdomen is distended with a symphysis-fundal height that is consistent with gestational age. Foetal movements are observed.

The following blood tests were conducted:

– Hb 138 g/L (Male: 135-180, Female: 115-160)
– Platelets 189 * 109/L (150-400)
– WBC 4.2 * 109/L (4.0-11.0)
– Na+ 138 mmol/L (135-145)
– K+ 4.2 mmol/L (3.5-5.0)
– Urea 5.2 mmol/L (2.0-7.0)
– Creatinine 88 µmol/L (55-120)
– CRP 4 mg/L (<5)
– Bilirubin 12 µmol/L (3-17)
– ALP 145 u/L (30-100)
– ALT 32 u/L (3-40)
– Albumin 36 g/L (35-50)

What is the most probable cause of her symptoms?

MRCP2-1053

A 42-year-old woman with Graves’ disease is referred by her GP for management of thyroid eye disease. She has a history of drinking 10 units of alcohol per week and smoking 20 cigarettes per day. On examination, she has a smooth goitre, marked proptosis, a fine tremor, and a blood pressure of 112/88 mmHg with a pulse of 89 beats per minute. What factor has the most significant negative impact on her thyroid eye disease prognosis?

MRCP2-1054

A 57-year-old woman visits the endocrinology clinic after a CT scan revealed a 3mm mass in her thyroid. The scan was originally done to assess her neck stability as she was scheduled for general anesthesia and intubation for a coronary arterial bypass graft. She has a medical history of type 2 diabetes mellitus, high cholesterol, and hypertension, but no symptoms of thyroid dysfunction. What is the best course of action?

MRCP2-1055

A 22-year-old female presents with a two-month history of fatigue, muscle pain, and unintentional weight loss. On examination, there are no significant findings. Her vital signs are within normal limits, with a heart rate of 72/min, respiratory rate of 14/min, oxygen saturation of 99% on room air, and blood pressure of 110/80 mmHg. She has no fever.

Routine blood tests are ordered, and the results are as follows:

– Hemoglobin: 150 g/l
– Platelets: 200 * 109/l
– White blood cells: 12.0 * 109/l
– Neutrophils: 8.0 * 109/l
– Lymphocytes: 4.0 * 109/l
– Sodium: 128 mmol/l
– Potassium: 2.9 mmol/l
– Urea: 7.0 mmol/l
– Creatinine: 85 µmol/l
– C-reactive protein: 11 mg/l

What is the most appropriate next step in the investigation for this patient?