Archives: MRCP Part 2

MRCP2-3604

A 75-year-old man presents to MAU with worsening dyspnea. He has a history of locally advanced lung cancer of the left upper lobe treated with chemo and radiotherapy. He reports a recent decline in his breathing over the past 48 hours, accompanied by a dry cough and minor hemoptysis. Although he has not felt well since completing his treatment several weeks ago, he has not felt worse until now. His wife recently received antibiotics for a cold. On examination, his temperature is 37.7°C, BP 130/85 mmHg, pulse 120 bpm regular, respiratory rate 18 bpm, and oxygen saturations 92% on 24% oxygen. Chest examination reveals dullness and reduced air entry over the left upper zone. Heart sound auscultation is normal, and abdominal examination is unremarkable. What is the most effective diagnostic test to determine the underlying cause of his worsening dyspnea?

MRCP2-3605

A 23-year-old woman is planning to move to Australia and had a chest x-ray done for her visa requirements. The x-ray showed bilateral hilar lymphadenopathy but clear lung fields, which was suspicious of sarcoidosis. She was referred to the outpatient clinic. During the review of her systems, she reported having arthralgia and a dry cough for the past two months. She had no significant medical history except for a negative HIV test three months ago after having unprotected intercourse. She used to live in Zimbabwe until she was 16 and currently works as a waitress. What test is most likely to confirm the diagnosis?

MRCP2-3606

A 40-year-old Chinese woman presents with a persistent headache for the past two months and nasal congestion. She denies having a fever, runny nose, or discharge. She also reports an enlarged lymph node in her neck. The patient moved to the United Kingdom at the age of 10 and is currently not taking any medications. On physical examination, she has bilateral cervical lymphadenopathy, normal oral examination, and no splenomegaly. Laboratory studies, including complete blood picture, LDH, metabolic profile, kidney function, and urinalysis, are normal. Panendoscopy reveals a soft-tissue mass in the nasopharynx. What is the most likely diagnosis?

MRCP2-3607

A 72-year-old woman presents with sudden-onset lower limb weakness and increasing mid-back pain over the past two weeks. She last passed urine the previous night and had a bowel movement a few days ago. She is unable to get out of bed this morning. Her medical history includes hypertension and a 15 pack-year smoking history. She underwent surgery for a locally spreading tumor 18 months ago at another hospital. On examination, she appears anxious but otherwise well. Neurological examination reveals increased tone in the lower limbs, no leg power, a sensory level at T6 to light touch and pinprick, brisk knee and ankle reflexes, upgoing plantars, and normal upper limbs and central nervous system. Chest X-ray shows multiple well-circumscribed lesions in the lungs. A urinary catheter is inserted, and 1.4 liters of urine is drained out. A preliminary diagnosis of cord compression is made, and magnetic resonance imaging is scheduled. What is the most likely primary cancer responsible for this presentation?

MRCP2-3608

A 39-year-old man presents with increasing shortness of breath and ankle swelling. He reports he is more short of breath, especially on exertion, which is not being relieved by the use of his salbutamol inhaler. He has also noticed his ankles are swollen by the end of the day.

His past medical history includes asthma, which is usually well controlled, and lymphoma, which was treated with chemotherapy several years ago. His only medications are his beclometasone and salbutamol inhalers. The results of his blood tests are shown below:

Hb 140 g/L (135-180)
Platelets 359 * 109/L (150 – 400)
WBC 7.2 * 109/L (4.0 – 11.0)
Na+ 137 mmol/L (135 – 145)
K+ 4.3 mmol/L (3.5 – 5.0)
Urea 5.9 mmol/L (2.0 – 7.0)
Creatinine 119 µmol/L (55 – 120)

His ECG showed sinus rhythm with left axis deviation. An echocardiogram was done which showed dilation of all four chambers of the heart and a left ventricular ejection fraction of 40%.

Which medication can be attributed to causing this man’s presentation?

MRCP2-3609

A 32-year-old female presents with a result of ‘moderate cervical cell changes’ on her routine Pap smear. What would be the recommended course of action for follow-up?

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?

MRCP2-3613

A 50-year-old woman, previously healthy, is referred by her gynaecologist with a new diagnosis of stage 3 ovarian cancer. She had been experiencing increasing abdominal pain and bloating for the past four months. Following a hysterectomy and bilateral salpingo-oophorectomy, she is now being referred for chemotherapy. What is the typical initial chemotherapy treatment for this condition?