Archives: MRCP Part 2

MRCP2-3596

A 50-year-old man presents with a recent history of weight loss and changes in bowel habits. Upon initial investigations, it is discovered that he has metastatic colorectal cancer with multiple liver metastases. The colorectal multidisciplinary team (MDT) determines that his liver metastasis is currently non-resectable and refers him to oncology for consideration of chemotherapy to downstage his disease in hopes of achieving surgical resection.

As part of his chemotherapy regimen, the oncology team considers combination therapy with cetuximab (Erbitux). To ensure successful treatment with cetuximab, which histopathological subtype is essential?

MRCP2-3597

A 55 year old patient has undergone six cycles of R-CHOP chemotherapy and is now attending the lymphoma follow up clinic. He reports experiencing persistent tingling in his feet and legs, as well as his right hand, along with pain in these areas that worsens in cold weather. Upon examination, the patient exhibits normal motor strength in all four limbs, but a significant reduction in proprioception in both legs below the knee and the right hand. There is a glove and stocking distribution of loss when tested for pinprick sensation, and a decreased joint position sense to the ankle in both lower limbs. Plantar reflexes are normal. Additionally, the patient has sustained an injury to the sole of their foot without realizing it. What is the most likely cause of these symptoms?

MRCP2-3598

A 56-year-old man presents with a mass located 8 cm from the anal verge during a routine colonoscopy. Biopsy results indicate moderately differentiated adenocarcinoma. Rectal ultrasonography reveals extension of the tumor into the perirectal fat, but no lymphadenopathy is detected. A CT scan of the chest, abdomen, and pelvis shows no evidence of metastatic disease. What is the most suitable treatment option at this stage?

MRCP2-3599

A 47-year-old female patient has been diagnosed with an 18 mm grade 3, left-sided breast cancer. After appropriate radiological and histological staging, she undergoes a Patey’s mastectomy and axillary node sampling. The final histology reveals an 18 mm grade 3 malignant carcinoma of no specific type, vascular invasion positive, and node positive (1 of 4 nodes sampled). The hormone receptor status shows ER Positive, H-score 300, 100% of cells, PR Positive, H-score 300, 100% of cells, and HER-2 Positive, 3+. The breast cancer multidisciplinary team (MDT) discusses her case and considers adjuvant chemotherapy and radiotherapy.

During her treatment with Herceptin (trastuzumab), which investigation is best for monitoring the patient?

MRCP2-3600

A 55-year-old female patient visits the dermatology outpatient department complaining of a scaly, erythematous rash on her hands that has been present for two months. She also reports skin discoloration on her eyelids and general muscle aches and pains, which she is managing with over-the-counter pain medication. Upon examination, the patient has scaly erythematous plaques on her MCP and ICP joints and a violaceous rash on her upper eyelids. Based on these symptoms, what is the most probable underlying malignancy?

MRCP2-3585

A 30-year-old man was admitted to the hospital with a pseudo-obstruction of the bowel. Although the condition settled conservatively, the surgical team noticed weakness in both legs and regular twitching of his facial muscles. His parents reported that he had been excessively sleeping and twitchy for a long time. The patient had a history of uveitis and irritable bowel disease. On examination, he appeared pale and thin with subnormal intelligence. Blood tests showed abnormalities in hemoglobin, white cell count, and albumin levels. A chest x-ray was normal, but an MR brain scan revealed multiple high signal areas within the white matter. Lumbar puncture results were also abnormal. What is the most likely diagnosis for this patient?

MRCP2-3587

A 16-year-old male presents with a one year history of shaking hands. He has noticed a decline in the shakiness of his hands during this time. He is currently working as an administrative clerk and has been experiencing difficulties with his handwriting. He denies any exposure to drugs or toxins and is not taking any medication. He mentions that his older brother has a neurological condition.

Upon examination, he appears to be in good physical condition with a BMI of 25, a pulse of 68 bpm, and a blood pressure of 116/64 mmHg. A neurological examination reveals a resting tremor, dysarthria, and bilateral cataract. His serum ceruloplasmin levels were normal.

What is the most appropriate investigation for this individual?

MRCP2-3589

A 38-year-old woman was successfully treated for mediastinal germ cell tumour using a combination of chemotherapy drugs (bleomycin, etoposide, and cisplatin) and achieved complete radiographic remission. It has been six years since her remission and she is currently doing well without any complications.

What is the most suitable course of action for managing her condition at this point?

MRCP2-3592

A 25-year-old asymptomatic woman has been referred to the genetics clinic due to her family history of breast cancer. Her grandmother passed away from the disease at the age of 54, and her mother and older sister have both been diagnosed with breast cancer recently. Despite a breast examination and ultrasound not revealing any concerning findings, what information should she be given regarding her risk of developing breast cancer?

MRCP2-3594

Cystic Fibrosis (CF) is an autosomal recessive disease that requires two abnormal alleles to be present for the disease to manifest. If one parent is a carrier (with one abnormal gene), they have a 1:2 chance of passing the abnormal gene to their offspring. Assuming the other parent is of the same genetic stock as those in the area of their birth, the chance of the child receiving an abnormal allele from both parents is calculated by multiplying the male risk (1/2), the female carrier risk (1/20), and the female risk of passing a gene on (1/2), resulting in a 1/80 chance of the child having CF. Other answer options include a 1/4 risk if both parents are confirmed carriers, a 1/40 risk if one partner is a homozygote for the abnormal gene and the carrier frequency is 1 in 20, a 1/160 risk if the carrier frequency is 1 in 40, and a 1/320 risk if the carrier frequency is 1 in 80.