MRCP Part 2 Category: Endocrinology, Diabetes And Metabolic Medicine

MRCP2-1495

A 25-year-old woman with limited exposure to medical services presents to the Endocrinology Clinic. She has never had a period and previously felt this was due to having a short height, but she has recently decided to seek advice.
On examination, she is significantly shorter than would be expected, given her parental height; her nipples are widely spaced and there is a suspicion of a high-arched palate. There appears to be a failure of secondary sexual characteristics. Her blood pressure is elevated at 149/90 mmHg.
Investigations reveal a follicle-stimulating hormone (FSH) level of > 40 IU/l on at least two occasions.
Given the likely diagnosis, what is the most likely complication in this patient?

MRCP2-1496

A 14-year-old boy presents with several months of muscle cramps and weakness all over his body. He also reports having an increased thirst and a strong desire for salty foods. He has no significant medical history.

During the examination, the boy appears to be in good health. His vital signs are as follows:
Respiratory rate of 18/min
Blood pressure of 116/78 mmHg
Heart rate of 78/min

Blood tests are performed, and the results are as follows:

Na+ 129 mmol/L (135 – 145)
K+ 2.8 mmol/L (3.5 – 5.0)
Magnesium 0.54 mmol/L (0.7 – 1.0)

A urine dipstick test shows no glucose or protein present. A urine sample is sent to the lab for further analysis:

Urine calcium/creatinine ratio 0.05 (<0.14) What is the most probable diagnosis?

MRCP2-1497

A 55-year-old obese HGV driver, who takes BD Novomix 30 insulin, visits your outpatient clinic seeking clarification on driving regulations he overheard while dining with colleagues. He is extremely anxious and tearful, fearing that his diabetes may cost him his livelihood.

The patient was diagnosed with type 2 diabetes 9 years ago and became insulin dependent 2 years ago. He reports good compliance with insulin every day. However, 18 months ago, he experienced dizziness after exercising and taking the same units of insulin. A spot blood glucose check revealed a reading of 2.8 mmol/l, which improved immediately after drinking Lucozade that he carried with him. He has no other medical history and no visual field or peripheral nerve impairments.

What advice would you give him regarding driving?

MRCP2-1498

A 63-year-old woman visits her doctor with complaints of hair loss, weight gain, and feeling lethargic. She reports no other health issues. The doctor orders thyroid function tests, and the results are:

– Thyroid stimulating hormone (TSH) 0.3 mu/l
– Free T4 8 pmol/l

What test is most likely to provide a definitive diagnosis?

MRCP2-1499

A 50-year-old man presents to the endocrinology clinic with abnormal blood test results. His GP had ordered thyroid function tests due to concerns about hair loss. The patient denies any other symptoms such as weight changes, temperature sensitivity, or mood changes. The GP suspected male-pattern hair loss but ordered the blood test anyway. The patient’s full blood count, renal function, and iron levels were all normal, but his TSH was 12mU/l and his free T4 was 12 pmol/l. On examination, there is no evidence of goitre.

What is the most appropriate management plan for this patient?

MRCP2-1500

A 26-year-old woman presents to the emergency department after being found unwell by friends. She has a history of vomiting and diarrhea for the past three days and her housemate reports that she has not been taking her regular insulin. The patient is disorientated and unable to provide any history. On examination, she is dehydrated with abdominal tenderness but no focal peritonism. Her vital signs show a blood pressure of 86/57 mmHg, heart rate of 127 beats per minute, respiratory rate of 28 per minute, and O2 saturations of 100% on room air. Her fingerpick blood glucose is 38.2 mmol/L and blood ketones are 8.7 mmol/L. Arterial blood gas shows a pH of 7.05, PaCO2 of 15 mmHg, PaO2 of 99 mmHg, bicarbonate of 12.3 mmol/L, chloride of 111 mmol/L, and lactate of 7.5 mmol/L. What is the appropriate strategy for intravenous insulin treatment in this patient?

MRCP2-1485

A 45-year-old woman presents with a history of recurrent lethargy, shakiness, slurred speech, and diplopia for the past year. Her symptoms usually occur in the mornings and resolve after breakfast. She has a medical history of type 2 diabetes mellitus, alcohol excess, and a functional neurological disorder.

Upon observation, her SpO2 is 97% on room air, respiratory rate is 22 breaths/minute, blood pressure is 92/64, heart rate is 116 beats per minute, and she is apyrexial. Her capillary blood glucose is 5.2, but during the review, she becomes shaky and feels unwell. A repeat blood glucose test shows 2.4.

Blood tests are ordered, and 40% dextrose gel is administered. The results of the blood tests show insulin levels of 43 pmol/L (<25), C-peptide levels of 114 pmol/L (<75), and pro-insulin levels of 23 pmol/L (3.6-22). What is the most likely diagnosis?

MRCP2-1486

A 35-year-old male with a history of asthma and HIV visits the HIV clinic for a check-up. He has been experiencing weight gain, marks on his abdomen, and his partner has noticed a more heavy-set appearance in his face over the past two months. He was diagnosed with HIV at 21 years old after sharing needles and using heroin. He has been on retroviral treatment since he was 22, taking tenofovir, emtricitabine, atazanavir, and ritonavir, and has had good control. His asthma has been well managed with only salbutamol until six months ago when he started taking regular fluticasone due to recurrent exacerbation from upper respiratory tract infections. His recent blood tests show an undetectable viral load and a CD4 count of 900 cells/microliter. What is the most likely explanation for his symptoms?

MRCP2-1487

A 20-year-old woman presents to her GP with a 6 month history of weight loss, diarrhoea and palpitations. The diarrhoea is normal colour and over the last two months she has had roughly 2-3 bowel motions per day. The heart palpitations occur randomly throughout the day and night. She has also noticed that she has recently been getting episodes of feeling very hot and sweaty. She has no other past medical history and her only family history is a mother who has Hashimoto’s thyroiditis.

On examination, the patient is sweaty and her blood pressure is 130/80 mmHg, pulse is 102 bpm and regular, respiratory rate is 16/min and her oxygen SATs are 98% on air.

Blood tests are performed and reveal:

Hb 135 g/l
Platelets 220 * 109/l
WBC 7.1 * 109/l
Na+ 139 mmol/l
K+ 3.9 mmol/l
Urea 5.1 mmol/l
Creatinine 60 µmol/l
Free thyroxine (T4) 28 pmol/l
Thyroid stimulating hormone (TSH) 0.08 mu/l

A thyroid radioisotope scan is performed and reveals a globally reduced uptake.

What is the most likely diagnosis?

MRCP2-1488

A 40-year-old woman presents to the Endocrinology Clinic with a 4-month history of amenorrhoea. She reports having to wax her arms and upper lip and her mother went through early menopause at 28 after having an emergency hysterectomy post-partum. On examination, her body mass index is 38 kg/m² but otherwise unremarkable. Her GP has ordered blood tests prior to her appointment. Based on the following results, what is the most likely diagnosis?

Investigations:

LH 40 IU/L (5 to 25 IU/L)

FSH 8 IU/ (1 to 11 IU/L)

Estradiol 720 pmol/L (70-500 pmol/L)

Progesterone 220 nmol/L (35-92 nmol/L)

Thyroid Stimulating Hormone 5.6 mIU/L (0.5 -6.0 mIU/L)

Prolactin 700 mIU/L (105-548 mIU/L)