Archives: MRCP Part 2

MRCP2-3515

A 35-year-old man comes to the Neurology Clinic for evaluation. He has been experiencing severe headaches every afternoon and evening, which are located in the frontal, like a band around his head and last for 1-2 hours each time. He has been taking 2g of Acetaminophen and 30 mg of Codeine phosphate four times a day, and has attempted to stop taking the medication, but the headaches return when he does. His neurological examination is normal, and his CT and MRI scans, as well as a variety of screening blood tests, have all come back normal.
What is the most appropriate next step?

MRCP2-3516

A 72-year-old male presents with visual loss.

During examination, it is found that his blood pressure is 168/102 mmHg and fundoscopy reveals an embolus to the right superior temporal branch of the retinal artery. Carotid dopplers are arranged and show normal left-sided carotids, but a 90% stenosis in the right external carotid artery and approximately 70% stenosis in the right internal carotid artery.

What is the most appropriate treatment for this patient?

MRCP2-3517

A 65-year-old retiree presents with difficulty recalling recent events. He reports consuming six glasses of wine daily. He shares a far-fetched tale about his day’s events. During the central nervous system (CNS) evaluation, you observe bilateral internuclear ophthalmoplegia. He has slight anemia, with an MCV of 110 fl, and a random blood glucose level of 4.2 mmol/l. What is the preferred treatment?

MRCP2-3518

A 70 year-old man experienced a sudden onset of painless visual loss in his right eye for 1 minute. He described it as a curtain descending across his vision. The patient has a history of hypertension. An ECG revealed sinus rhythm, while a Doppler of his carotids showed a 90% stenosis in the right external carotid artery and a 40% stenosis in the right internal carotid artery. What is the best course of treatment for this patient?

MRCP2-3519

A 65-year-old man has been diagnosed with Alzheimer’s disease and is being seen in a memory clinic. Over the past three months, his cognitive function has declined, and his wife reports that he is struggling with basic tasks such as dressing and eating. She has also noticed a decrease in speech, but his personality remains intact. He has experienced nausea and diarrhea. He has been taking donepezil 10 mg/day for six months, with initial improvement for the first three months. He has no other medical history and takes no other regular medication. His wife is his primary caregiver.

During the examination, the patient had a normal demeanor and interacted well. He scored 11/30 on the mini-mental state examination, with deficiencies in recall, visuospatial tasks, language, and executive function. He exhibited marked dyspraxia on testing alternating hand movements. Examination of the cranial nerves appeared normal, and examination of the peripheral nervous system revealed brisk lower limb reflexes with extensor plantar responses.

What would be the appropriate management plan for this patient?

MRCP2-3520

A 20-year-old man comes to your follow-up clinic after experiencing his first episode of generalised tonic-clonic seizures. The seizure lasted for 5 minutes and involved all four limbs before stopping on its own. He was referred to a first fit clinic and underwent an EEG and MRI, both of which showed no significant abnormalities. The patient and his family are now seeking your advice on how to manage his seizures. What is the most suitable course of action?

MRCP2-3521

An elderly man, aged 75, is admitted to the medical assessment unit with bilateral leg weakness and a decline in his vital capacity over the past three days. He had recently experienced a bout of gastroenteritis. After diagnosis, what is the most effective disease-modifying treatment to administer early in the course of Guillain-Barré syndrome (GBS)?

MRCP2-3522

A 65-year old male presents with a five-day history of tingling in his fingers and toes. He has also experienced progressive weakness in his upper and lower limbs over the last two days, and is now unable to walk without assistance. Upon examination, he has a tetraparesis, areflexia, and a flexor plantar response. The CSF examination reveals no red or white cells, a CSF glucose level of 3.6 mmol/L (3.3-4.4), a plasma glucose level of 5.2 mmol/L (3.0-6.0), and a CSF protein level of 1.3 g/L (0.15-0.45). What is the most appropriate treatment?

MRCP2-3523

A 20-year-old man is referred to the Neurology Clinic after presenting with a 2-year history of jerking of his upper limbs on waking, lasting for a few seconds. He has also had a few episodes of jerking during the day. He attended the clinic with his partner, who described several episodes in the last few months where he would stop speaking and stare into the distance for up to 10 seconds.

He has no significant past medical history and his only regular medication is ibuprofen for occasional headaches. He is currently working as a software engineer. His BMI is 23 and his blood pressure is 120/80 mmHg. Neurological examination is normal.

Which anti-epileptic drug would be most appropriate for this patient, given the likely epilepsy syndrome?

MRCP2-3524

Given the case of an 18-year-old Pakistani man who has been referred for advice after abnormal blood test results and behavioral changes, which investigation is most diagnostically relevant? The patient’s blood test results show low hemoglobin, high white cell count and platelets, high bilirubin, low albumin, and elevated liver enzymes. His family reports hostility and irritability for the past year, and his academic performance has declined. He was admitted to the Short-stay Psychiatric Ward for further evaluation. On examination, he displayed slurring dysarthria, tremors in his right upper limb, and fixed flexion in his right toe and ankle. Tone was increased in his limbs, and rapid alternating movements of the fingers were slow. The question is, which investigation is most diagnostically relevant?