Archives: MRCP Part 2

MRCP2-3679

A 50-year-old woman has been diagnosed with metastatic breast cancer that has spread to her liver and bones. She has undergone chemotherapy with the FEC combination and has responded well to the treatment. Due to her cancer being strongly ER positive, she has been prescribed anastrozole to maintain the disease response. However, during her follow-up appointment after two months, she appears to be unwell and is showing signs of jaundice. Her doctor has ordered blood tests, tumour markers, and a repeat CT scan of her chest, abdomen, and pelvis. Which of the following tumour markers are used to evaluate disease activity in metastatic breast cancer?

MRCP2-3680

A 28-year-old male patient visits his family doctor after discovering a lump in his left testicle. The lump is painless and the patient is unsure how long it has been there. He has no significant medical history, except for a case of chickenpox at the age of 10. He is a moderate smoker, consuming 5 cigarettes per day.

During the examination, the doctor detects a firm, well-defined non-translucent lump (approximately 1.5 cm) attached to the left testis. After conducting laboratory tests, scrotal ultrasound is performed, revealing the presence of a homogeneous hypoechoic testicular mass. CT scanning of the abdomen and pelvis with IV and oral contrast fails to identify any metastatic disease. The patient undergoes a radical inguinal orchidectomy, and the histology report confirms a pure seminoma that was confined to the testis.

Which of the following serum tumor markers is the most specific for this diagnosis?

MRCP2-3681

A 62-year-old woman complains of epigastric discomfort that radiates to her back. She is diagnosed with pancreatic cancer and undergoes an intensive course of chemotherapy. What serial measurements may suggest a recurrence or advancement of the disease?

MRCP2-3682

A 20-year-old man presents to his primary care physician (PCP) with complaints of persistent lower right-sided back pain for the past few weeks. He reports that the pain has been gradually increasing in intensity. Upon further questioning, he reveals that he has lost approximately 5 kg in weight over the last month. He denies any recent travel history.
During the physical examination, a tender and palpable mass is detected over his right iliac crest. The PCP orders an urgent MRI scan and routine blood tests. The blood results show mild anemia but no leukocytosis, and C-reactive protein levels are normal. The MRI findings are consistent with a diagnosis of Ewing’s sarcoma.
Which of the following factors is most strongly associated with a poor prognosis in this patient?

MRCP2-3683

As the medical doctor in charge of an acute admission unit, you receive a patient who is an elderly male with recently diagnosed ovarian cancer. He is currently on day 8 of cisplatin chemotherapy and presents with a temperature of 39°C, tachycardia at 130 bpm, blood pressure 128/68 mmHg, respiratory rate 14/min, and sats 98% on room air. The patient is complaining of abdominal pain and has been vomiting today. Bloods and blood culture have been sent and you are awaiting the results. The chest x-ray was normal and urine dipstick clear. What is the most appropriate antibiotic therapy to initiate for this patient?

MRCP2-3684

A 68-year-old man came for his routine follow-up in the oncology clinic. He has metastatic poorly differentiated adenocarcinoma of unknown primary and started palliative chemotherapy with oxaliplatin and fluorouracil two months ago. His recent CT scan showed stable disease.

He was admitted to the local emergency department ten days ago with a fever and diagnosed with neutropenic sepsis, but the cause was unclear. He received IV Tazocin for five days and was discharged with co-amoxiclav and filgrastim (G-CSF). Currently, he feels well, and there are no abnormalities on examination.

His observations are as follows: saturations 95%, respiratory rate 14/min, blood pressure 152/83 mmHg, heart rate 69/min, and temperature 37.3°C. His blood tests from 14 days ago showed Hb 135g/l, platelets 322* 109/l, and WBC 0.2* 109/l. Today, his blood tests showed Hb 124g/l, platelets 285* 109/l, and WBC 23.6* 109/l.

What is the most appropriate course of action?

MRCP2-3685

A 70-year-old man presents to the emergency department with progressive shortness of breath over the last two weeks, which worsens when leaning forward. His wife has noticed changes in his appearance, with facial swelling and discoloration. He has a medical history of right-sided heart failure, myocardial infarction, type two diabetes, COPD, and small cell lung cancer diagnosed three months ago. He used to smoke 20 packs of cigarettes a year and drinks moderate amounts of alcohol.

During the examination, he appears calm at rest, but his face is swollen and slightly purple. His neck veins are distended, and his JVP is significantly elevated to 4cm. Bibasal crepitations are heard during auscultation, and there is pitting edema at the ankles. A chest X-ray shows a widened mediastinum. What is the most appropriate investigation to establish the diagnosis?

MRCP2-3665

A 50-year-old woman with bony metastases from breast cancer presents to the Emergency Department with symptoms of vomiting, dehydration, increasing drowsiness, and confusion over the past five days. Despite her condition, she has been able to work part-time for a charity and maintain a good quality of life. On examination, she appears agitated on abdominal palpation and is drowsy and confused. Her vital signs are stable, with a BP of 100/80 and a pulse of 88 and regular. Laboratory investigations reveal abnormal levels of Hb, WCC, PLT, Na, K, Cr, and Ca. She is given 1 litre of 0.9% sodium chloride stat, and a second litre is commenced. What is the most appropriate next intervention?

MRCP2-3666

A 60-year-old man with no significant medical comorbidities is brought by ambulance to the Emergency Department in status epilepticus.

A computed tomography (CT) head scan shows a right temporal mass with a hypodense, necrotic centre, irregular, heterogeneous margins with contrast enhancement and surrounding vasogenic oedema. He undergoes maximum safe resection and makes a straightforward recovery. Histology is consistent with glioblastoma multiforme.

A follow-up magnetic resonance imaging (MRI) head shows changes consistent with the surgery but no signs of recurrence. He attends the Neuro-Oncology Clinic with his daughter, who confirms he is back to his baseline level of functioning, walking about five miles a day, and has no significant post-surgical deficit.

What is the most appropriate management option?

MRCP2-3671

A 55-year-old postmenopausal woman presented to the hospital with complaints of right-sided abdominal pain. Upon physical examination, she was found to be stable. Pelvic examination revealed the presence of an adnexal mass. Further investigation through abdominal and pelvic ultrasonography confirmed ovarian torsion. The patient underwent a right-sided oophorectomy, during which the tumour was found to be confined to one ovary with an intact capsule and no ascites. A postoperative CT scan showed no other masses. What is the most appropriate postoperative management for this patient?