Archives: MRCP Part 2

MRCP2-3188

A 35-year-old man who is 25 weeks pregnant with his first child comes to the Emergency Department. He has been experiencing increasingly severe morning headaches over the past four weeks and, over the past three days, has developed double vision and feels that his vision is fading when he leans forward. Upon examination, his blood pressure is 120/80 mmHg and his pulse is 80 bpm and regular. He is obese with a body mass index of 34 kg/m2. There is bilateral papilloedema, but his eye movements are unaffected.
Investigations;
Investigations Results Normal Values
Haemoglobin (Hb) 120 g/l 115–155 g/l
White cell count (WCC) 6.5×109/l 4–11 × 109/l
Platelets (PLT) 180×109/l 150–400 × 109/l
Sodium (Na+) 138 mmol/l 135–145 mmol/l
Potassium (K+) 4.0 mmol/l 3.5–5.0 mmol/l
Creatinine 92 µmol/l 50–120 µmol/l
Computed tomography (CT) head and CT venogram with abdominal shield, Normal intracranial appearances, no venous sinus thrombosis identified
What is the most appropriate next step?

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?

MRCP2-3190

A 53-year-old man presents to the Neurology clinic with a 2-month history of nocturnal headaches and difficulty walking. Upon examination, he displays an ataxic gait and impaired coordination affecting his left arm and leg. Blood tests reveal normal results, except for a slightly elevated CRP level. A CT brain scan is performed, which shows a well-defined, low attenuation region in the posterior fossa with an enhancing nodule on the wall. What is the probable underlying lesion causing these symptoms?

MRCP2-3169

A 50-year-old male patient is diagnosed with an aggressive glioma after presenting with an inaugural seizure. What is the next step in the standard of care for this tumour, given its aggressive nature?

MRCP2-3170

A 42-year-old male patient complains of weakness that began in his feet and hands and has now spread to his limbs, making it difficult for him to swallow. He recently had food poisoning, which has since resolved.

Which of the following test results is the best predictor of the need for invasive ventilation in the near future?

MRCP2-3171

A 16-year-old girl has been experiencing severe back pain for the past two days. Despite undergoing a plain x-ray film of her spine, the results came back normal. However, two days later, she began to feel tingling sensations in her fingers and toes. The following day, she felt generally weak and decided to seek medical attention at the emergency department.

Upon examination, the girl displayed bilateral lower motor neurone facial weakness, tetraparesis with weakness in all limbs (4/5), areflexia, flexor plantars, and normal sensation. A lumbar puncture was performed, and the CSF analysis showed protein levels of 1.4 g/L (<0.4), normal glucose levels, and 0 cells (<5 ml−1). What is the most likely diagnosis?

MRCP2-3172

You are requested to assess a 25-year-old male patient who has been admitted to the hospital with an ascending muscle weakness that started in his toes but has now spread to all his limbs. He is experiencing shallow breathing and has no reflexes, although he has preserved sensation. At present, his cranial nerve examination is normal, and he is fully oriented. He has no medical history except for a bout of diarrhea three weeks ago, and he is not taking any medications. What is the probable diagnosis?

MRCP2-3174

A 20-year-old farm worker presents with a two-day history of progressive weakness and tingling in all limbs. He had a recent episode of respiratory symptoms that resolved without treatment. On examination, he has decreased muscle strength and absent deep tendon reflexes in his legs. Laboratory results are within normal limits except for slightly elevated plasma urea and CSF protein. What is the most critical parameter to monitor in this patient?

MRCP2-3175

A 29-year-old male presents with progressive weakness in his lower limbs over the course of two weeks, accompanied by feet, hand, and perioral paresthesia. Upon examination, he exhibits reduced reflexes and normal tone in his lower limbs, as well as reduced proprioception in his feet and hands, and proximal weakness in his lower limbs. An MRI of his spine shows no abnormalities.

Further testing reveals a CSF protein level of 2.0g/L, and he tests negative for HIV, Lyme disease, and Epstein-Barr virus. What is the appropriate course of treatment for this patient?

MRCP2-3176

A 50-year-old male presents with ascending weakness. He first noticed that he was tripping over more easily, but now has trouble getting out of a chair. He feels otherwise well. Of note, he did have mild diarrhoea which had completely resolved a week prior to developing this weakness.

On examination, he is haemodynamically stable with a heart rate of 70 beats per minute and a blood pressure of 130/80 mmHg. His respiratory rate is 16 breaths per minute. He has reduced power in ankle plantar and dorsiflexion bilaterally, absent ankle jerks and reduced knee jerks. His plantar responses are downwards.

Which of the following results will most assist you with a diagnosis in this acute presentation?