Archives: MRCP Part 2

MRCP2-3662

A 56-year-old postmenopausal woman presents with ductal carcinoma in situ (DCIS) of the left breast. During a routine mammogram, a 2 cm area of micro-calcifications was identified and subsequent biopsy revealed high-grade, oestrogen receptor-positive, progesterone receptor-positive DCIS. The patient underwent lumpectomy and radiation therapy, and physical examination shows a well-healed left lumpectomy scar with no palpable masses in either breast and no axillary or supraclavicular lymphadenopathy. What is the most appropriate next step in treatment?

MRCP2-3663

A 50-year-old woman has been diagnosed with metastatic breast cancer after experiencing acute confusion caused by malignant hypercalcaemia. A CT scan revealed multiple lytic lesions throughout her skeletal system, including multiple spinal metastases. She received a single dose of radiotherapy to T12 to stabilise a metastatic lesion encroaching on her spinal canal and began FEC combination chemotherapy. Unfortunately, she was readmitted with malignant hypercalcaemia and prescribed another medication to control her metastatic disease. Although the patient stabilised on this combination treatment, she was readmitted several weeks later with multiple non-healing painful lesions on her gums and had lost almost all of her teeth. On examination, several non-healing gingival ulcers were found where the mandible was exposed.

What medication has caused the loss of teeth in this patient?

MRCP2-3664

A 50-year-old woman presents with an incidental finding of a thyroid nodule during a routine physical exam. She has no significant medical history and no family history of thyroid disease or malignancy. On examination, a non-tender 2 cm thyroid nodule is palpable, and there is no cervical lymphadenopathy. Blood tests, including thyroid-stimulating hormone level, are within normal limits. Fine-needle aspiration of the nodule confirms papillary carcinoma. What is the most appropriate treatment for this patient?

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?

MRCP2-3667

A 67-year-old woman presents with abdominal swelling and constipation, which has been progressively worsening over the past three weeks. She was admitted to the gynaecology ward due to her inability to manage at home any longer. Prior to admission, her performance status was 0. An ultrasound of her abdomen revealed a large pelvic mass and gross ascites, which has since been drained. The cytology report shows adenocarcinoma cells with occasional psammoma bodies. A CT scan of her chest, abdomen and pelvis reveals an 8 cm mass arising from the left ovary with multiple deposits throughout the peritoneum suggestive of metastatic spread. What is the recommended first-line chemotherapy treatment for this patient?

MRCP2-3668

An 80-year-old man is referred by his GP for evaluation of a rising serum prostate-specific antigen (PSA) level. He is not experiencing any symptoms at present.

The patient was diagnosed with prostate cancer four years ago, with a Gleason score of 7 and a PSA level of 18 ng/mL [18 µg/L]. He underwent radioactive seed implants to the prostate, which resulted in an undetectable PSA level. However, a recent bone scan has revealed multiple metastatic lesions.

What is the most appropriate course of management for this patient?

MRCP2-3669

A 67-year-old woman presents with pain in her left upper extremity, left hip, and right lower extremity that has been ongoing for three weeks. She has a history of stage I breast cancer, which was treated with a lumpectomy, radiation therapy, and five years of tamoxifen therapy that ended two months ago. She is not currently taking any pain medications. On physical examination, there is tenderness over the left humerus and right femur, but no local recurrence is found on breast examination and the rest of the physical examination is normal. A bone scan and plain radiographs reveal lytic lesions, but no impending fractures. Biopsy of a bone lesion confirms adenocarcinoma consistent with a primary breast tumour that is oestrogen receptor-positive, progesterone receptor-negative, and HER2-negative. What is the most appropriate next step in treatment?

MRCP2-3670

A 67-year-old man presents with left flank pain and abdominal fullness. Upon physical examination, the patient appears to be in good health with stable vitals and normal cardiopulmonary function. However, a firm mass is detected in the left flank that moves with respiration. Urinalysis reveals haematuria. A CT scan of the abdomen and pelvis confirms the presence of an 8 cm mass in the left kidney, while a chest x-ray shows multiple pulmonary nodules. Biopsy results indicate clear cell renal carcinoma. What is the most appropriate course of treatment at this time?

MRCP2-3672

A 50-year-old woman presents with a three-month history of discomfort in the lower right quadrant of her abdomen. She had her last menstrual period two weeks ago and has been experiencing regular menses. During a pelvic examination, fullness was noted in the right adnexal region. An ultrasound revealed a solid mass in the left adnexa, and a CT scan confirmed the presence of an 8 cm adnexal lesion, omental studding, and peritoneal carcinomatosis. What is the most appropriate management for this patient?