Archives: MRCP Part 2

MRCP2-3178

A 42-year-old woman presented to the hospital with a severe headache on the right side and loss of vision that had been going on for two days. She had a history of hypertension and was taking bendroflumethiazide. Her family had a history of thyroid problems, and she had experienced intermittent headaches in the past, although they were not regular. On examination, she was agitated and distressed, with a temperature of 37.5°C, a pulse of 110 beats per minute, and a blood pressure of 145/95 mmHg. The right eye showed chemosis and proptosis, with upward and downward gaze paralysis and preserved lateral gaze. The right pupil was dilated and unresponsive to light, while the left eye was normal. Bilateral papilloedema was observed during fundoscopy. What is the most likely diagnosis?

MRCP2-3180

A 32-year-old man presents with complaints of difficulty concentrating and irregular jerky movements in his extremities and fingers. He reports consuming around 20 units of alcohol per week and has a family history of dementia, with his father being diagnosed at the age of 40. On examination, he displays generalised choreiform movements, but his neurological and systemic examination is otherwise unremarkable. What is the probable diagnosis?

MRCP2-3181

A 50-year-old man presents to the emergency department with a sudden onset headache that began 2 hours ago while he was at work. He denies vomiting but reports feeling nauseated. His medical history includes hypertension and he takes ramipril, amlodipine, and indapamide.

Upon examination, his GCS is 15/15. His heart rate is 80 beats/min and his blood pressure is 150/92 mmHg. There are no signs of head trauma. His pupils are equal and reactive to light, but he complains of photophobia.

What is the immediate management for this patient?

MRCP2-3182

A 27-year-old female patient presents to the Emergency Department complaining of a severe headache that has been progressively worsening over the past two to three months. She also reports experiencing blurred vision. The patient has a history of depression, which she attributes to her weight problem and bad skin. However, she has been actively trying to address these issues by joining Weight Watchers and receiving treatment for her acne from her GP for the past four months. On examination, the patient is overweight and has moderately severe acne. She is afebrile, and there are no signs of nuchal rigidity. The oropharynx is benign, and the neurological examination is normal, except for blurred disc margins bilaterally and a limited ability to abduct the left eye. What is the most likely diagnosis?

MRCP2-3183

A 26-year-old female patient is admitted with a history of headaches for the past eight weeks. The headaches have worsened significantly over the last two days and are now constant and unbearable. The patient has found some relief from paracetamol, but the headaches have been problematic in the morning. The patient has gained 6 kg in weight over the last six months. On examination, the patient is noted to be obese with a BMI of 32 kg/m2 and a blood pressure of 122/76 mmHg. Fundoscopy reveals bilateral swelling of both optic discs with loss of venous pulsation, but otherwise, neurological examination is normal. Investigations reveal normal MRI appearances of the brain, and a lumbar puncture reveals an opening pressure of 30 cm H2O, but CSF analysis is normal. What is the most likely diagnosis?

MRCP2-3184

You assess a 27-year-old female patient who complains of frequent headaches and transient vision disturbances. She also experiences dizziness and double vision on several occasions. Her BMI is 32 and bilateral papilloedema is observed during the examination. A CT scan shows no mass lesion, but a lumbar puncture reveals an elevated opening pressure. You suspect the patient has idiopathic intracranial hypertension (IIH).
What risk factor is associated with a higher prevalence of idiopathic intracranial hypertension?

MRCP2-3185

A 26-year-old female patient has been experiencing headaches for six weeks, which worsen in the morning and when lying down. She also reports diplopia and brief episodes of visual loss (lasting seconds) upon standing up. On clinical examination, the patient is found to be obese with a blood pressure of 120/70 mmHg. Fundoscopy reveals bilateral blurring of optic discs and horizontal diplopia when looking towards the right. A CT scan of the brain without contrast shows no abnormalities. What is the most appropriate next investigation for this patient?

MRCP2-3186

A 44-year-old white Caucasian female presents to the Emergency Department with complaints of being unable to walk and problems with vision in her right eye. She has no significant medical history and has only visited her GP once before for a bout of diarrhoea and vomiting.

On examination, a right relative afferent pupillary defect is noted, and there is a patchy loss of sensation on the right lateral wrist and anterior aspect of the left lateral shin. An urgent MRI head and whole spine reveals abnormal high signal in the cervical cord from C3 to C7. A lumbar puncture was performed, and the results show a WCC of 12 mm/³, RBC <1 mm/³, protein of 0.9 g/l, glucose of 5.2 mmol/l (10.2 mmol/l serum), and oligoclonal bands and viral PCR results are pending. What is the most likely diagnosis?

MRCP2-3187

A 65-year-old woman presented with symptoms of dizziness, nausea, and vomiting that had developed gradually over the past day. She reported a constant sensation of the room spinning, which worsened with sudden movements. The patient had experienced flu-like symptoms the previous week, which were now resolving. During the examination, the patient exhibited horizontal nystagmus with the fast beat towards the right. Speech was normal, and finger-nose testing and gait were normal. There was no past-pointing, and the patient had 5/5 power throughout all limbs. Hearing was normal. What is the most likely diagnosis?

MRCP2-3189

A 50-year-old man presents with complaints of lower limb numbness and weakness, along with recent urinary incontinence and blurred vision. On examination, he has bilateral lower limb weakness (grade 3+/5) with spastic tone and exaggerated reflexes. Sensory level is at T10. MRI of the spine shows a hyper intense lesion spanning from T7-T12. His medical history includes well-controlled asthma with salbutamol inhaler. Laboratory investigations reveal normal electrolytes, renal function, and urine analysis, with negative ANA. CRP and ESR are mildly elevated. Which investigation would be most helpful in reaching a diagnosis?