Archives: MRCP Part 2

MRCP2-3775

A 40-year-old female presents with symptoms of polyuria, nocturia, and general lethargy that have been ongoing for two months. She has a history of psychiatric illness and is currently taking medication for it. The patient is a smoker, consuming 12 cigarettes per day, and drinks approximately five units of alcohol per week.

During examination, the patient is found to be obese with a BMI of 32.3 kg/m2, a pulse of 82 beats per minute, and a blood pressure of 142/88 mmHg. No abnormalities are noted during the examination.

The following investigations were conducted:
– Haemoglobin: 133 g/L (115-165)
– White cell count: 5.6 ×109/L (4-11)
– Platelets: 210 ×109/L (150-400)
– Serum sodium: 136 mmol/L (137-144)
– Serum potassium: 4.2 mmol/L (3.5-4.9)
– Serum urea: 4.2 mmol/L (2.5-7.5)
– Serum creatinine: 88 µmol/L (60-110)
– Fasting glucose: 15.5 mmol/L (3.0-6.0)
– Serum calcium: 2.3 mmol/L (2.2-2.6)
– Serum phosphate: 0.96 mmol/L (0.8-1.4)
– 24-hour urine volume: 2.1 litres
– Dipstick urine Glucose +

Which of the following agents could be responsible for this patient’s presentation?

MRCP2-3776

A 25-year-old male is admitted after a paracetamol overdose. He took fifteen 500mg tablets. He states that he wants to end his life and that he sees no purpose in living anymore. He had left a note for his girlfriend. On mental state examination, he displays poverty of thought, a flat affect, and signs of nihilistic delusions. He has a history of severe depression. Although he is medically stable, he is transferred to a psychiatric unit for further evaluation due to persistent suicidal thoughts. During his stay, he develops catatonia and refuses to eat or drink.

Is there an absolute contraindication for electroconvulsive therapy in this case?

MRCP2-3777

A 32-year-old male comes to the clinic complaining of difficulty leaving his house due to fear of being in situations where he cannot escape, such as busy places like shopping malls and public transport. However, he reports functioning well at home and work, both in terms of productivity and interpersonal relationships.

What is the probable diagnosis?

MRCP2-3778

A 50-year-old man is being seen at the psychiatric clinic after being referred by his GP who has been struggling to manage his depression. The patient has a medical history of hypertension, high cholesterol, a previous acute coronary syndrome one year ago, and depression. He reports that his mood has deteriorated and he is experiencing persistent suicidal thoughts, to the extent that he is afraid he may act on them. He denies any cognitive impairment, concentration difficulties, or sleep disturbances. What guidance should be provided to him regarding driving?

MRCP2-3779

A 42-year-old accountant presents with an acute inferior myocardial infarction and is urgently scheduled for percutaneous coronary intervention (PCI). He has a history of smoking 30 cigarettes a day and hypercholesterolaemia. He occasionally drinks alcohol but denies any drug use.
The next day, he experiences restlessness, rapid heartbeat, and excessive sweating. His blood pressure is 160/75 mmHg, with a pulse rate of 110 and regular rhythm. Although his ECG does not show any new ischaemic changes, there is significant baseline interference due to the development of a tremor.
What is the appropriate course of action for his management?

MRCP2-3780

A 19-year-old man is being reviewed before discharge from the Neurology Ward. He was admitted electively for the second time for video and EEG telemetry to characterize witnessed seizures. His mother shows a home video of him behaving irrationally, pacing, and then falling to the floor. He shakes all four limbs and then suddenly stops. He remains groggy for several hours following the event and has been hospitalized on at least five occasions. These events happen at least three times per week, but none have been captured by video telemetry or EEG during his 5-day admission. He has no family history of epilepsy, although his mother is diabetic.

Clinical examination is unremarkable, and an MRI head has shown no intracranial or localizing lesions. Blood tests recorded at a recent Emergency Department presentation are within normal limits.

What is the next appropriate management step?

MRCP2-3781

A 32-year-old professional has been referred due to excessive drinking for the past two weeks. He has been feeling low for about a month, frequently crying and lacking interest in both work and sex. He acknowledges having experienced similar low periods in the last decade. However, he also describes having phases of high energy, during which he is sociable, productive, and positive. He claims to abstain from alcohol during these times. What is the probable diagnosis?

MRCP2-3782

A 65-year-old man comes to the clinic complaining of confusion, difficulty walking, and urinary incontinence that have been getting worse over the past two months. Upon examination, he displays mild cognitive dysfunction and gait ataxia. A CT scan of his brain shows enlarged ventricles with no signs of obstruction to CSF outflow. A lumbar puncture reveals normal CSF pressure and constituents. What is the most effective management step to take?

MRCP2-3783

You are requested to evaluate a 35-year-old woman who is presenting with symptoms of emotional distress. She reports experiencing intense anxiety and fear for the past eight months, accompanied by palpitations, tremors, sweating, and a sensation of suffocation. There is no identifiable trigger for these episodes, which typically last for 10-15 minutes and can occur in various settings, including when she is at rest. However, they are most frequent when she is riding on an escalator. She has no signs of psychosis. She has visited the Emergency department twice, believing she was having a heart attack, but all tests were normal. She had similar episodes five years ago, which gradually resolved. Her mother had a history of depression, and her father died of a heart attack at the age of 45. Her overall physical health is good, and she is alert and oriented. Her cognitive abilities are intact, except for mild difficulty concentrating. What is the diagnosis?

MRCP2-3784

You are requested to evaluate a 35-year-old woman who is experiencing emotional turmoil. She reports having episodes of intense anxiety and fear for the past eight months, accompanied by palpitations, tremors, sweating, and a sensation of suffocation. She cannot identify any specific trigger for her symptoms. These episodes, which typically last 10-15 minutes, occur in various situations, including when she is at ease. However, they are most frequent when she is riding on an escalator. She has no psychotic symptoms and has visited the emergency department twice, believing she was having a heart attack, but all tests were normal. She had similar episodes five years ago, which gradually resolved. Her mother had depression, and her father died of a heart attack at the age of 45. She is in good overall physical health, alert and oriented, with only minor concentration difficulties and intact cognitive abilities. Which brain region is most likely involved in this patient’s condition?