MRCP2-3360
A 6-year-old girl falls from the top of a swing and is taken to the Emergency Department. She is crying, complaining of a severe headache and regularly vomiting. A CT head is performed:
What does the scan show?
Archives: MRCP Part 2
MRCP2-3361
A 78-year-old man is brought to the Emergency Department by ambulance after being discovered in an unresponsive, drowsy state. His son had called earlier in the day and was told that his father had a headache. Upon arriving at his father’s home, he found him confused and lying on the floor.
During examination, the patient’s GCS is 9/15 (M4V3E2), pulse is 96/min, and blood pressure is 140/78 mmHg. A CT head scan is ordered:
What is the most probable diagnosis?
MRCP2-3362
A 68-year-old male is brought to the emergency department by ambulance after experiencing his third episode of limb jerking in 72 hours witnessed by his wife. Upon arrival, the patient becomes increasingly unresponsive and exhibits small amplitude jerking in all four limbs. While the resus nurse obtains midazolam two minutes into his seizure, it is noted that his eyes are tightly closed and cannot be forcefully opened to check pupillary reflexes. The amplitude of his limb jerking also increases. Blood is observed on his tongue and he experiences urinary incontinence, but there is no evidence of head or limb injury. The seizure spontaneously terminates before any medication is administered, approximately 6 minutes after onset. The patient becomes increasingly responsive about 2 minutes after the end of limb jerking and appears tearful, expressing apologies for the inconvenience caused. What is the most likely diagnosis?
MRCP2-3363
A 56 year old man experiences a gradual onset of hand clumsiness, difficulty walking, and trouble swallowing over the course of several months. His voice has also become high-pitched and nasal. Despite these symptoms, his sensory examination has remained normal. He has up-going plantars, absent ankle reflexes on both sides, and muscle wasting in his lower legs. What treatment has been proven to extend the lifespan of the underlying condition?
MRCP2-3364
A 14-year-old male presents to your clinic with complaints of increasing fatigue at school over the past 2 months. His parents are worried that he relies on large amounts of Lucozade to stay alert during his secondary school exams. He denies any headaches. The patient had a normal pregnancy and development until he was 12 years old when he underwent chemotherapy and radiotherapy for an optic chiasm glioma, causing him to miss a year of school. He returned to school after treatment and has been achieving good grades. There is no significant past medical or family history.
Upon examination, the patient is short for his age (at 2nd centile) and lacks facial hair or other secondary sexual characteristics. He has a BMI of 13.7 kg/m² and appears thin. Chest, cardiovascular, and abdominal examinations are unremarkable, and there are no skin lesions. Neurological examination, including cranial nerves, is normal.
The initial blood tests reveal the following results:
Hb 142 g/l
MCV 89 fl
Platelets 410 * 109/l
WBC 7.4 * 109/l
Na+ 139 mmol/l
K+ 4.6 mmol/l
Urea 5.1 mmol/l
Creatinine 44µmol/l
FSH low
ACTH low
TSH 0.13 mu/l
What is the most likely diagnosis?
MRCP2-3335
A 58-year-old man presents to his GP with complaints of left arm pain. He reports experiencing the pain while lifting weights and during exercise, which causes him to feel weak, dizzy, and nauseated. He has even passed out twice without warning. The patient also reports neck pain and recently had an MRI scan that showed some degenerative changes in his vertebrae. He has a medical history of hypertension and hypercholesterolemia and takes atenolol and simvastatin regularly. He is a smoker and drinks approximately 20 units of alcohol per week. He works as a builder and is married with two adult children.
During the examination, the patient’s blood pressure was 150/78 mmHg in the right arm and 120/67 mmHg in the left arm. Bilateral carotid bruits were present, but heart sounds were normal, and the chest x-ray was normal. Neurological examination showed normal tone, depressed reflexes at the biceps and brachioradialis, and a brisk triceps jerk. There was impaired pinprick sensation over the thumb and middle finger in the left hand, but no weakness, atrophy, or fasciculations were observed. The cerebellar system appeared intact.
Carotid Doppler studies revealed 70% stenosis of the left internal carotid artery and 50% stenosis of the right internal carotid artery. Based on these findings, what is the most likely diagnosis for this patient?
MRCP2-3336
A 65-year-old man was brought to the Emergency department after a fall in his bathroom.
Seen immediately by his family, he was already picking himself up from the floor and said he was not injured. His wife felt that he was transiently dazed.
On examination, he was alert, and no abnormalities were noted. His medical history included a history of hypertension for which he was taking bendroflumethiazide 2.5 mg daily. He was discharged without any further intervention.
Two weeks later his wife brings the patient to see you because the dazed state has returned. Examination reveals a temperature of 36.7°C, a pulse rate of 84 bpm regular, a blood pressure of 152/94 mm Hg.
On questioning he is slightly slowed, being disoriented to time with some deficit in recent memory. The patient moves slowly, but power is normal. Neurologic examination shows slight hyperactivity of the tendon reflexes on the right with unclear plantar responses because of bilateral withdrawal.
What tests or evaluations would you request?
MRCP2-3338
A 36 year old construction worker presents to the emergency department after sustaining a severe cut to his upper arm while on the job. During the suturing process, the physician notices multiple burns and cuts on both of his arms.
Upon examination, the patient displays significant atrophy of the brachioradialis and small muscles in both hands, along with mild hyporeflexia of the biceps and brachioradialis tendons. He experiences weakness in both arms, particularly distally. However, his lower limb and cranial nerve assessments are unremarkable. Upper limb sensation, vibration, and proprioception are intact, but there appears to be reduced pain and temperature sensation over the C3/C4/C5 dermatomes. What diagnostic test would be most beneficial in this case?
MRCP2-3339
A 42-year-old chef presents to a neurologist with progressive wasting and weakness of the right hand. He has been experiencing reduced dexterity and clumsiness while at work for several months. Additionally, he has burnt his hands while cooking or smoking without realizing it, resulting in multiple sores over the fingertips of both hands. He has no known medical history but did sustain a whiplash injury in a recent minor car accident. On examination, there is evidence of right dorsal interossei, hypothenar eminence, adductor pollicis brevis, and forearm wasting. Power, handgrip, and wrist flexion/extension are asymmetrically weak (right>left). Sensation is reduced for pain and temperature affecting both arms and anterior/posterior chest wall. What is the likely diagnosis for this patient based on the history and examination findings?
MRCP2-3340
An 80-year-old resident of a nursing home presented to the neurology clinic with a history of Alzheimer’s disease. Her behavior had become increasingly challenging over the past four months, leading to the initiation of regular haloperidol. However, the nursing home staff reported that over the last four weeks, she had developed involuntary movements of her mouth, including frequent tongue protrusion and lip-smacking. Despite stopping the haloperidol two weeks ago, her symptoms had worsened. On examination, she displayed continuous involuntary lip-smacking, tongue protrusion, and frequent eye-blinking, but was otherwise well and alert. What is the most likely cause of her symptoms?