MRCP Part 1 Endocrinology and Nephrology

Question 1

A 35-year-old woman presents with weight gain, moon face, abdominal striae, and proximal myopathy. Her 24-hour urinary free cortisol is elevated. What is the next most appropriate investigation?

Accepted Answer

Overnight dexamethasone suppression test

Answer

MRI pituitary

Answer

CT adrenals

Answer

ACTH stimulation test (Synacthen test)

Question 2

A patient with type 2 diabetes has an eGFR of 35 mL/min/1.73m2 and persistent albuminuria (ACR 45 mg/mmol) despite maximal ACE inhibitor therapy. According to NICE, which additional medication should be considered?

Accepted Answer

SGLT2 inhibitor (dapagliflozin)

Answer

Calcium channel blocker

Answer

Alpha-blocker

Answer

Spironolactone

Question 3

A 28-year-old woman presents with a thyroid nodule. Fine needle aspiration cytology is reported as Thy3f (follicular neoplasm). What is the recommended management?

Accepted Answer

Diagnostic hemithyroidectomy

Answer

Total thyroidectomy

Answer

Radioiodine ablation

Answer

Observation and repeat ultrasound in 6 months

Question 4

A patient presents with severe hypercalcaemia (corrected calcium 3.8 mmol/L) causing confusion and dehydration. What is the most important initial treatment?

Accepted Answer

Intravenous 0.9% sodium chloride

Answer

Intravenous zoledronic acid

Answer

Oral prednisolone

Answer

Calcitonin injection

Question 5

Which antibody is most specific for type 1 diabetes mellitus?

Accepted Answer

Anti-GAD65 antibodies

Answer

Anti-nuclear antibodies

Answer

Anti-smooth muscle antibodies

Answer

Anti-thyroid peroxidase antibodies

Question 6

A 60-year-old man with CKD stage 4 has a potassium of 6.8 mmol/L. ECG shows tall tented T waves but no QRS broadening. After IV calcium gluconate, what is the next most appropriate treatment to lower potassium?

Accepted Answer

Insulin-dextrose infusion (10 units actrapid in 50 mL 50% glucose)

Answer

Oral calcium resonium

Answer

IV sodium bicarbonate alone

Answer

Oral furosemide