MRCP Part 1 Endocrinology and Nephrology 2

Question 1

A 50-year-old woman presents with lethargy, weight gain, and constipation.
TSH is 45 mU/L (normal 0.4-4.0) and free T4 is 4 pmol/L (normal 9-25).
Anti-TPO antibodies are strongly positive.
What is the most likely diagnosis?

Accepted Answer

Hashimoto's thyroiditis

Answer

Graves' disease

Answer

Toxic multinodular goitre

Answer

Subacute (de Quervain's) thyroiditis

Question 2

A 45-year-old man presents with episodic headaches, sweating, and palpitations. His blood pressure is 220/130 mmHg. 24-hour urine metanephrines are markedly elevated. What is the diagnosis?

Accepted Answer

Phaeochromocytoma

Answer

Essential hypertension

Answer

Conn's syndrome

Answer

Cushing's syndrome

Question 3

A patient with end-stage renal disease on haemodialysis has a PTH of 85 pmol/L (normal 1.6-6.9), low calcium, and high phosphate. What is this condition called?

Accepted Answer

Secondary hyperparathyroidism (renal osteodystrophy)

Answer

Primary hyperparathyroidism

Answer

Tertiary hyperparathyroidism

Answer

Hypoparathyroidism

Question 4

A 25-year-old woman presents with polyuria, polydipsia, and a random plasma glucose of 22 mmol/L. Urine dipstick shows glucose 3+ and ketones 3+. Blood gas shows pH 7.15, bicarbonate 8 mmol/L. What is the initial fluid replacement?

Accepted Answer

0.9% sodium chloride 1 litre over 1 hour

Answer

5% dextrose 1 litre over 1 hour

Answer

Hartmann's solution 500 mL over 30 minutes

Answer

0.45% sodium chloride 1 litre over 2 hours

Question 5

A 55-year-old man with type 2 diabetes has a urine ACR of 8 mg/mmol on two consecutive samples. His blood pressure is 142/88 mmHg. According to NICE, what is the first-line antihypertensive?

Accepted Answer

ACE inhibitor (ramipril)

Answer

Amlodipine

Answer

Bendroflumethiazide

Answer

Doxazosin

Question 6

A patient on lithium for bipolar disorder presents with polyuria and polydipsia. Serum sodium is 148 mmol/L and urine osmolality is 180 mOsm/kg despite fluid restriction. What has lithium caused?

Accepted Answer

Nephrogenic diabetes insipidus

Answer

Cranial diabetes insipidus

Answer

SIADH

Answer

Psychogenic polydipsia