Archives: MRCP Part 2

MRCP2-3559

A 29-year-old male presents to the acute medical unit with confusion. His girlfriend reports that he has been increasingly confused over the past few days. He has a history of epilepsy and is currently taking sodium valproate. On examination, myoclonus is noted and his Glasgow coma score is reduced to 13 (M6, V4, E3).

The following blood results are obtained:

Hb 142 g/l Na+ 138 mmol/l Bilirubin 14 µmol/l
Platelets 388 * 109/l K+ 4.4 mmol/l ALP 82 u/l
WBC 10.8 * 109/l Urea 5.8 mmol/l ALT 24 u/l
Neuts 8.4 * 109/l Creatinine 72 µmol/l γGT 36 u/l
Lymphs 1.2 * 109/l Albumin 42 g/l Plasma ammonia 65 μmol/L (normal range 11–32 μmol/L)

What is the appropriate treatment for this patient?

MRCP2-3560

A 49-year-old man presents to the Emergency department with sudden onset of left posterior auricular pain while working under his car in the garage. He develops vertigo, nausea, and intractable hiccups within the next few hours. The patient has a medical history of migraine and hypertension and takes atenolol 50 mg for both. He has no family history of medical or neurological problems. On examination, there is nuchal stiffness and pain with neck flexion. Cranial nerve examination reveals dysarthria and left Horner’s syndrome, with restricted horizontal gaze and reduced pinprick sensation over the left side of the face. Upper and lower limb examination shows reduced pinprick and temperature sensation on the right side, with an ataxic gait. Laboratory investigations are unremarkable except for a slightly elevated white cell count and platelet count. What is the most likely diagnosis?

MRCP2-3562

A 31-year-old female presents with four episodes of loss of consciousness within the past 4 weeks. She denies palpitations or chest pain but reports sudden onset binocular black dots in visual fields, occasional flashing lights, dysarthria and hearing loss, all of which resolves after about 60 minutes. She is unsure about the relevance of an occipital headache, onset with frequency of about three times per week for the past year. She denies any limb weakness, altered sensation or facial droop. She has no past medical history or family history of epilepsy. Your neurological examination, including fundoscopy is unremarkable. An EEG is unremarkable. What is the probable diagnosis?

MRCP2-3563

A 54-year-old man visits his GP complaining of dizziness and headache that have persisted for 3 months. He has a medical history of hypertension and chronic obstructive pulmonary disease. The neurology department is consulted, and an outpatient MRI head is scheduled, as depicted below:

What condition is the most probable diagnosis?

MRCP2-3564

A 40-year-old man with a history of epilepsy visits the clinic with a complaint of tunnel vision.

Which medication is the most probable cause of this issue?

MRCP2-3565

A 55-year-old woman presents with a history of progressive gait problems and recurrent falls over the past six months. She has a medical history of hypothyroidism and insulin-dependent diabetes, and drinks 10 units of alcohol per week. Her family has a history of diabetes and hyperthyroidism. On examination, she has a broad-based gait and needs to look down at the floor when walking. She also has a positive Romberg’s test. MRI brain and whole spine show patchy demyelination in the dorsal columns. What is the most likely diagnosis?

MRCP2-3566

A 70-year-old man presents to the emergency department with sudden onset weakness. He has a medical history of hypertension and atrial fibrillation and is currently taking amlodipine, bisoprolol and apixaban. Upon examination, he has 4/5 power in his right upper and lower limbs, left eye deviation, left-sided ptosis, and normal pupillary responses. A CT head scan shows no abnormalities. Which cerebral artery is most likely affected in this case?

MRCP2-3567

A 45-year-old man with chronic alcohol abuse is brought to the Emergency department by the police after being found wandering the streets at 3 am. He has a history of multiple admissions related to alcohol abuse.

Upon examination, he appears dishevelled, confused, and has a strong smell of alcohol. He is disoriented in time and place, with a mini-mental score of 16/30. His blood pressure is 138/90 mmHg, and he is apyrexial. He has bilateral sixth nerve palsies, gaze-evoked nystagmus, and gait ataxia.

What is the appropriate treatment for this patient?

MRCP2-3568

An 80-year-old man is admitted to the acute medical unit after experiencing a sudden loss of consciousness. He reports having a severe headache earlier in the day, which started at the back of his head and quickly escalated to a 10/10 level of pain.

The following investigations are ordered:

CT head Blood found in the sulci, fissures, basal cisterns, and ventricles.

What would be the most suitable course of action now?

MRCP2-3569

A 72-year-old man is brought to the emergency department after being found unresponsive in his armchair by his wife. Prior to this, he had been feeling well. On examination, bilateral 1 mm pupils are noted and his Glasgow coma score is 4 (M2, E1, V1). The patient has a medical history of hypertension, hypercholesterolemia, and osteoarthritis, and is currently taking codeine, paracetamol, ramipril, and atorvastatin. Despite administering 400 micrograms of naloxone, there is no change in GCS or pupil size. What is the most likely diagnosis?