Archives: MRCP Part 2

MRCP2-3622

A 67-year-old woman with a history of metastatic breast cancer to her liver and bones presents to the medical admissions unit with confusion five days after starting her first course of palliative capecitabine chemotherapy. She appears dehydrated and disoriented in place and time during the mental state examination. Her vital signs are stable, with a temperature of 36.5°C, pulse of 90 BPM regular, BP of 130/80 mmHg, oxygen saturations of 99% on air, and respiratory rate of 18. There are no other notable findings on examination.

What would be the most appropriate initial investigation to perform?

MRCP2-3623

A pediatric patient receiving chemotherapy calls for the nurses to report pain and swelling around the area where the infusion cannula was inserted. The oncology resident suspects that this may be caused by the leakage of the chemotherapeutic drug into the surrounding tissue.

What additional steps would be required following the initial treatment of this young patient?

MRCP2-3624

A 30-year-old woman is undergoing adjuvant chemotherapy for primary breast cancer. The cancer is a grade 3 lobular type invasive cancer with clear vascular invasion and is ER negative, PR negative, and HER-2/neu negative. The patient received her first dose of adjuvant docetaxel 10 days ago and has been admitted to the Medical Assessment Unit (MAU) due to central abdominal pain that has recently localized to the right iliac fossa.

Upon examination, the patient has a fever of 38.4°C, a regular pulse of 120 bpm, a blood pressure of 135/80 mmHg, oxygen saturations of 98% on air, and a respiratory rate of 12 bpm. Abdominal examination reveals tenderness of the right iliac fossa to superficial palpation but no rebound tenderness. Bowel sounds are present and active.

An urgent CT scan shows acute edema of the caecum and ascending colon. Based on these findings, what is the most likely diagnosis?

MRCP2-3625

A 55-year-old man with a history of smoking presents with haemoptysis and weight loss. Upon examination, he is found to have clubbing and clinical evidence of right pleural effusion. His serum calcium levels are elevated at 3.2 mM (2.2-2.6 mmol/L), and a bone scan shows no abnormalities. Based on these findings, what is the most likely histological type of lung cancer he is suffering from?

MRCP2-3626

A 49-year-old woman is currently receiving multiple rounds of chemotherapy for breast cancer. She seeks advice from the oncology team as she experiences severe nausea and vomiting that lasts for several days, 2-3 days after chemotherapy, despite taking antiemetics during and after the treatment. What is the most suitable medication to prevent this delayed reaction?

MRCP2-3627

A 67-year-old man with a history of metastatic prostate cancer to the spine and right hip presents with right jaw pain that has been ongoing for four weeks. He recently had a right lower molar dental extraction six weeks ago. The patient is currently taking Oxycontin for pain and receives monthly IV zoledronic acid. A bone scan performed one month ago showed no changes over the past six months. He is also on leuprolide for prostate cancer. On physical examination, he has a temperature of 38.0°C (100.4°F), blood pressure of 116/70 mm Hg, pulse rate of 72/min, and respiration rate of 14/min. There is swelling over his right mandible with tenderness and limited mouth opening. His recent prostate specific antigen (PSA) is undetectable. What is the most likely diagnosis?

MRCP2-3628

A 75-year-old man presents to the emergency department after experiencing a generalized tonic-clonic seizure at home. He did not fully regain consciousness during transport and had another seizure shortly after admission. The doctor in charge was able to stop the seizure with 2 mg of IV lorazepam, but the patient’s GCS remains at 9.

Upon reviewing the patient’s medical history, it is discovered that he has undergone two rounds of chemotherapy in the past six months for metastatic malignant melanoma with multiple brain metastases. He was last seen in the clinic one month ago, where it was determined that he had no viable treatment options left.

The patient’s family wishes to speak with you. What is the best course of action?

MRCP2-3610

A 55-year-old woman visits the dermatology clinic complaining of a rash that has been gradually worsening in both her axillae for the past three months. She first noticed it while shaving, and although she is concerned about its cosmetic appearance, she is not worried about its cause. She has a family history of type 2 diabetes and has recently been feeling full after small meals, which she attributes to her successful attempt to lose weight through dieting. During the examination, diffuse brown, velvety hyperpigmentation is observed in both axillae. There are no underlying masses, and the hyperpigmentation is non-tender. What is the most probable underlying diagnosis?

MRCP2-3611

A 65-year-old woman has been diagnosed with metastatic breast cancer to her lungs and bones. For the past two years, she has been undergoing various endocrine treatments to control her disease. Currently, she is taking exemestane 25 mg once daily, but her latest CT scan shows that her disease has progressed. The multidisciplinary team (MDT) has discussed her case and decided to switch her treatment to fulvestrant 500 mg subcutaneously every three weeks. What is the mechanism of action of fulvestrant?

MRCP2-3612

A 55-year-old woman presents to her GP with a painless lump in the lower left quadrant of her right breast and new-onset nipple discharge. She is worried about her family history of breast cancer and is referred to the triple breast assessment clinic. A biopsy confirms breast cancer and she undergoes successful surgery with good margins, but with positive lymph nodes. As she awaits discussion at the MDT, she contacts the breast cancer nurses with concerns about her prognosis. What is the most useful factor in determining the prognosis of her breast cancer?