Archives: MRCP Part 2

MRCP2-3686

A 50-year-old woman with recurrent breast cancer presents with confusion, abdominal pain and constipation. A recent bone scan did not reveal any ‘hot spots’.

Investigations reveal the following:

Sodium (Na+): 135 mmol/l (normal value: 135–145 mmol/l)

Potassium (K+): 3.4 mmol/l (normal value: 3.5–5.0 mmol/l)

Creatinine (Cr): 120 µmol/l (normal value: 50–120 µmol/l)

Urea: 10.0 mmol/l (normal value: 2.5–6.5 mmol/l)

Corrected calcium (Ca2+): 3.5 mmol/l (normal value: 2.20–2.60 mmol/l)

What is the most likely cause of her presentation?

MRCP2-3687

A 36-year-old individual with recently diagnosed stage III diffuse large B cell lymphoma is being evaluated for CHOP chemotherapy along with supplementary rituximab. What is the most frequently observed side effect linked to rituximab treatment?

MRCP2-3691

A 65-year-old man with a known diagnosis of localised squamous cell lung carcinoma of the right upper lobe presents to the medical assessment unit (MAU) with a three-day history of headache. He describes the headache as a tight band across his forehead that worsens when he sits forward. The patient has also noticed increasing shortness of breath during the past three days but denies any haemoptysis or sputum production. He is not currently undergoing any treatment with chemotherapy or radiotherapy.

During examination, the patient is apyrexial with a regular pulse of 100 BPM and a blood pressure of 135/85 mmHg. Oxygen saturations are 96% on air, and respiratory rate is 12 bpm. Moderate facial swelling with some dilation of the veins of his neck is noted, but chest examination is unremarkable.

What is the appropriate initial treatment for this patient?

MRCP2-3692

A 58-year-old man suddenly becomes unwell on the oncology unit. He is receiving an intravenous infusion of a new chemotherapy agent as part of a clinic trial. He says he feels very lightheaded.

On examination his blood pressure is 80/50 mmHg, heart rate is 120/min, oxygen saturations are 94% on air and bilateral wheeze is heard on auscultation of the chest. An ECG shows a sinus tachycardia of 120 beats per minute.

The infusion is stopped, the patient is lay flat with their legs raised and an arrest call has been put out. What is the immediate medication that should be administered?

MRCP2-3693

A 57-year-old male with non-hodgkin’s lymphoma is on his fourth cycle of R-CHOP chemotherapy. He has experienced nausea in the past but is now two days following the most recent cycle and has been admitted to the hospital due to uncontrollable vomiting.

He is vomiting more than 20 times a day and the fluid is green to clear. He has no appetite and has difficulty swallowing water. He is not experiencing diarrhea. He takes indapamide regularly and ondansetron as needed, but this has not helped him, even though his oncologist suggested doubling his dose of ondansetron.

During the examination, he appears pale and has dry mucous membranes. He is alert, has a clear chest, and a soft abdomen, but he begins to retch when he sits forward. He last urinated six hours ago, and his vital signs show a heart rate of 115 beats per minute and a blood pressure of 90/65 mmHg. The emergency department starts him on intravenous fluids.

What is the most effective medical intervention for this patient?

MRCP2-3694

A 62-year-old man comes to the endocrinology clinic with a noticeable lump in his neck. He reports that he discovered it by chance. He denies any difficulty in swallowing, speaking, or breathing. However, upon further questioning, he admits to losing 3kg of weight over the past four months, which he cannot explain but is content with as he has always been overweight. The patient has a medical history of hypertension, high cholesterol, and appendicectomy. He is currently taking aspirin and atorvastatin. His thyroid function tests are normal. During the examination, a firm and non-tender mass of approximately 3 cm is detected in the anterior neck triangle on the left side. What is the most appropriate next step in the investigation?

MRCP2-3695

A 65-year-old man with metastatic prostate cancer is scheduled for radiotherapy in an hour. The nursing staff reports that he experienced pain during the transfer yesterday. Despite this, his pain has been effectively managed with a total of 60mg morphine daily. What is the optimal approach to managing his pain during today’s transfer?

MRCP2-3696

A 68-year-old man with lung cancer is admitted to the hospital by his spouse due to experiencing peculiar symptoms. He has begun to make odd facial expressions, protrude his tongue, and struggle with speaking. Despite this, his vital signs are stable, and he appears to be cognizant of his surroundings. His wife is curious if a medication he began taking three days ago could be responsible for his condition. Which of the listed medications is the probable culprit for his symptoms?

MRCP2-3697

You are requested to assess a 93-year-old man on the Geriatric Ward who has been admitted for end-of-life care after a massive intracerebral haemorrhage. He has not required any pain relief or sedation until now, but the nursing staff urgently asks you to see him as he has experienced a generalised tonic-clonic seizure with residual right-sided twitching.

Upon examination, you observe that his blood pressure is 190/98 mmHg. He is unconscious, but you notice intermittent, right-sided clonic jerks of the face and arm. His pupils are dilated bilaterally and unresponsive. Every few minutes, this seems to progress into generalised seizure activity for a brief period.

What is the most appropriate course of action?

MRCP2-3699

A 65-year-old man is admitted to hospice with metastatic bowel cancer and a prognosis of days to short weeks. What factors would prompt a palliative care physician to consider offering him a blood transfusion?