Archives: MRCP Part 2

MRCP2-3750

A 65-year-old man has been admitted to the urology department due to difficulty passing urine and back pain. A bladder scan revealed 980 mls of urine in his bladder, and he was catheterized by the admitting doctor, which resulted in haematuria. The patient has a medical history of metastatic prostate cancer, hypertension, hypercholesterolemia, hypothyroidism, atrial fibrillation, and a previous NSTEMI. He is currently taking warfarin and modified-release morphine 30 mg every 12 hours.

The urology consultant has recommended inserting a 3-way catheter if the haematuria persists and referring the patient to the palliative care team for pain management. The palliative care specialist has suggested increasing the modified-release morphine to 45 mg every 12 hours.

What is the appropriate dosage of immediate-release morphine for the patient’s breakthrough pain?

MRCP2-3751

You are caring for an 85-year-old man with a history of metastatic colorectal carcinoma and end-stage renal failure. He is experiencing significant pain and is currently receiving 6mg of alfentanil via a syringe driver. What additional analgesic medication will you prescribe for breakthrough pain?

MRCP2-3752

A 50-year-old woman with breast cancer and bone metastases presents with back pain, bilateral leg weakness, and a sensory level at L1. What does the NICE guidance recommend for the management of metastatic spinal cord compression (MSCC)?

MRCP2-3753

A 35-year-old woman with metastatic breast cancer is scheduled for her third cycle of palliative chemotherapy. However, she has experienced vomiting at home on the morning of her previous two treatments. What is the best medication to manage her vomiting?

MRCP2-3754

A 68-year-old man with advanced small cell lung cancer that has spread to other parts of his body arrives at the Emergency Department showing signs of restlessness. He seems disoriented and is making unintelligible noises. He is uncooperative with the nursing staff’s attempts to measure his vital signs and becomes agitated when touched. He is breathing rapidly and using additional respiratory muscles.

What is the most suitable initial treatment for this patient?

MRCP2-3755

An 80-year-old man with metastatic prostate cancer is admitted to the palliative care unit for end of life care. He is currently receiving morphine, levomepromazine, and midazolam via a syringe driver. The nursing staff has reported that he experiences severe pain when being turned onto his side during personal care, despite his pain being well controlled throughout the day.

How should his pain be managed in this situation?

MRCP2-3756

A 32-year-old man with a history of Crohn’s disease presents to the Emergency Department (ED) with complaints of abdominal pain. He was diagnosed with Crohn’s disease at the age of 26 after presenting to his General Practitioner (GP) with persistent symptoms of diarrhea, weight loss, and abdominal pain. At the time of diagnosis, he was noted to have an elevated C-reactive protein (CRP) and fecal calprotectin. He has been managed by a dedicated gastroenterology service and has been on a maintenance dose of Infliximab for the past year. He has started a new job as a air flight controller and has been experiencing increased stress due to the COVID-19 pandemic. His current medications include paracetamol as required and Infliximab every 8 weeks. He denies any rectal bleeding or changes in bowel habits. This is his third presentation to the hospital within the past year.

On examination, his abdomen is tender in the right lower quadrant with no rebound tenderness. Bowel sounds are present. A pregnancy test, urine dip, and routine blood tests are unremarkable. A recent CT scan of his abdomen showed mild inflammation in the terminal ileum, consistent with his known Crohn’s disease. A recent colonoscopy showed mild inflammation in the cecum and ascending colon.

What is the most appropriate management choice for this patient?

MRCP2-3738

A 55-year-old man has been admitted due to pain control and overall deterioration. He was diagnosed with metastatic lung cancer three years ago and has recently been found to have liver and bone metastases.

The patient has been experiencing significant pain control issues and has required increasing doses of opiates from his GP. At the time of admission, he was taking 200 mg morphine sulphate (modified release) twice daily.

The patient’s wife contacted his GP as he had become increasingly drowsy and nauseated over the past few days. She also expressed concern about significant lower limb jerks and mentioned that he had not passed urine in 24 hours.

What would be the most appropriate next step in managing this patient?

MRCP2-3741

A 68-year-old man with metastatic lung cancer is in the final stages of life and requires end of life care. The medical team plans to use a syringe driver to manage his symptoms as he cannot take medications orally. However, some medications may not be compatible when mixed together in a solution, leading to precipitation issues. Which of the following drug combinations can be safely mixed with water for injection in a syringe driver?

MRCP2-3742

You are requested to provide guidance on a patient who is in their late 60s and has metastatic renal cell carcinoma with pulmonary and bone metastases. They are receiving community palliative care at home, but their swallowing ability has started to decline. It is now believed that they are nearing the end stage of their illness, and a decision has been made to initiate a syringe driver. They have reported satisfactory pain management with their current analgesic regimen.

The patient’s current analgesic regimen consists of 60mg oxycodone modified-release capsules taken twice daily, along with oxycodone instant-release as needed. The oxycodone modified-release dose is converted to the equivalent subcutaneous dose for an oxycodone syringe driver.

What would be the appropriate dose of breakthrough analgesia to prescribe based on the current syringe driver dose?