Archives: MRCP Part 2

MRCP2-4647

A 42-year-old woman presents with fatigue, loss of appetite, gradual weight loss, and occasional chest pain. She also reports a rash on her nose and cheeks that worsens in the summer and joint pain in her wrists, knees, and ankles. On examination, her blood pressure is 150/94 mmHg, and she has a facial rash. Her test results show a low hemoglobin level, low white blood cell count, low platelet count, prolonged partial thromboplastin time, elevated C-reactive protein, high sodium and potassium levels, elevated creatinine, and blood and protein in her urine. What is the most specific test to determine her underlying diagnosis?

MRCP2-4648

A 40-year-old woman presents to the Pulmonary Clinic with complaints of a persistent cough and increasing shortness of breath on exertion over the past three years. She has a history of smoking five cigarettes per day and occasional alcohol consumption. She reports normal bowel movements but has noticed increased urination and thirst over the past eight months. The patient also complains of back pain and difficulty bending forward for the past six months.

Upon examination, bilateral crepitations were heard in the upper regions of both lung fields. Her blood pressure is 120/80 mmHg and her heart rate is 96 bpm. Oxygen saturation on room air was 94%.

Which diagnostic test would confirm the diagnosis in this patient?

MRCP2-4649

A 46-year-old woman comes to the Rheumatology Clinic complaining of progressive swelling in both hands and shortness of breath. She has noticed her hands becoming whiter at times for many years. Lately, she has started experiencing dyspnoea on exertion of up to 400 yards, with occasional palpitations.

The patient has been smoking 15 cigarettes a day for 20 years and drinks 14 units of alcohol a week. She is currently taking lansoprazole for gastro-oesophageal reflux disease, as prescribed by her General Practitioner.

During the examination, evidence of calcinosis is found in her hands. Autoantibodies are checked, which reveal a positive anti-centromere antibody. What is the most probable cause of this patient’s exertional dyspnoea?

MRCP2-4650

A 28-year-old woman presents to Rheumatology clinic with a two-year history of widespread pain and fatigue. She reports difficulty concentrating at work and feeling unrefreshed after sleep. She denies any skin rashes, hair loss, or weight loss. Her medical history is significant for mild depression, which was treated with cognitive behavioural therapy. She lives with her husband and two children and has ongoing financial concerns. She smokes 10 cigarettes per day and rarely drinks alcohol.

Initial evaluation reveals no evidence of inflammatory arthritis but significant muscular tenderness at multiple sites. Blood tests, including rheumatoid factor and anti-nuclear antibody, are negative, and X-rays of the hands and feet are normal.

At a follow-up visit, fibromyalgia is suspected, and the patient expresses a desire to manage her symptoms with positive lifestyle changes rather than medication. What is the most effective treatment for this patient?

MRCP2-4651

A 67-year-old woman presents to the rheumatology outpatient department with complaints of bilateral knee pain that worsens with movement. She has a medical history of hypertension and takes amlodipine. She has a smoking history of 20 years, smoking five cigarettes per day, and does not consume alcohol. She works as a cleaner.

During the examination, mild swelling is observed in both knees, and there is patellofemoral crepitus. No joint swelling or tenderness is noted elsewhere. Cardiorespiratory examinations are normal.

What is the most suitable course of action?

MRCP2-4620

A 42-year-old, left-handed man presents with complaints of pain in his left wrist for the past 4 months. He has also noticed some mild discomfort in his right wrist. He works as a carpenter and has been struggling to perform his job. On examination, there is a localised swelling and tenderness over the dorsal aspect of the left wrist and mild tenderness over the radial aspect of the right wrist. Blood tests including haematology and biochemistry are within normal limits. What is the most probable diagnosis?

MRCP2-4621

A 23-year-old patient presents with a palpable purpuric rash on their arms and chest. They report experiencing flu-like symptoms and mild joint pain.
What should be the next course of action in managing this patient?

MRCP2-4622

A 56-year-old man with rheumatoid arthritis (RA) has been taking methotrexate for six months and has seen significant improvement in his joint symptoms. He is currently on a regimen of methotrexate 15 mg/week, folic acid 5 mg/day, and hydroxychloroquine 200 mg bd. His regular blood tests have been normal until recently. The results of his most recent blood test show deranged liver function tests, with elevated AST and ALT levels. His other blood parameters, including haemoglobin, WBC, neutrophils, platelets, bilirubin, and alkaline phosphatase, are within normal ranges. His urea, electrolytes, and creatinine levels are also normal. What is the most likely cause of his abnormal liver function tests?

MRCP2-4623

A 23-year-old male patient, who has a history of hereditary angioneurotic oedema (HAO), presents with recurring fever, arthralgia, and a rash on his upper chest and face. Despite receiving treatment for his HAO, he has been experiencing recurrent attacks and has needed adrenaline on multiple occasions. His C4 levels have consistently been low due to his HAO. What is the probable reason for his current symptoms?

MRCP2-4624

A 56-year-old woman with SLE affecting skin and joints has been taking azathioprine (100 mg/day) and hydroxychloroquine 400 mg/day for the past four years. She presents with a sudden onset of a large blind spot in her right eye. Upon examination, a positive scotoma is noted in her right visual field. There is no history of headache, and retinal fundoscopy and the rest of the nervous system examination are normal. Her recent blood test results show normal urea, electrolytes, and creatinine levels, with a haemoglobin level of 131 g/L (115-165), WBC of 8.2 ×109/L (4-11), neutrophils of 7.1 ×109/L (1.5-7), platelets of 180 ×109/L (150-400), ESR of 28 mm/hr (0-20), and CRP of 12 mg/L (<10). What is the most likely cause of her visual loss?