Archives: MRCP Part 2

MRCP2-3135

A 50-year-old sailor presents with recent weight loss of 2 kg. Upon further inquiry, he reports experiencing painful sensations in his legs at night, reduced sensation in his feet, and some issues with balanitis and urinary frequency. During the examination, he exhibits diminished proprioception at the toes, absent ankle reflexes, and a small painless ulceration on the ventral aspect of the big toe. His BMI is 28 kg/m2. Nerve conduction studies reveal reduced motor conduction velocities (75% of normal) in the legs, with small, poorly formed sensory nerve action potentials. Electromyography shows evidence of active denervation in the lower limbs with positive sharp waves and fibrillations. What is the most probable diagnosis?

MRCP2-3136

An 80-year-old man presented to the general medicine outpatient clinic with complaints of short term memory loss and reduced mobility. His wife reported a seven month history of poor concentration and described episodes in which her husband would be in a world of his own followed by periods where he could be completely normal. More recently he had had disturbing visual hallucinations. On examination, he had a marked dysarthria and perseveration, and bilateral rigidity and bradykinesia but no rest tremor. Investigations revealed normal blood tests. Based on these findings, what is the most likely diagnosis?

MRCP2-3137

A 32-year-old female equestrian had recently purchased new riding boots and a saddle for her horse. She had a long history of chronic low back pain and had been prescribed pain medication by her primary care physician. After a strenuous horseback riding session, during which her horse had performed well, she dismounted and experienced severe pain in her left leg, making it difficult to walk.

Upon examination, she exhibited a left foot drop, with the evertors and dorsiflexors of the left ankle measuring 2/5, while inversion of both ankles was 5/5. The straight leg-raising test was 80° on both sides, and tendon reflexes were normal. Pinprick sensation was reduced in the left foot.

What is the most likely diagnosis?

MRCP2-3138

A 35-year-old woman presents to the Emergency Department with a first episode of generalised tonic-clonic seizure. She is accompanied by her husband, who says she collapsed after coming home from work and suffered 3 minutes of generalised limb jerking, some foaming at the mouth and incontinence of urine.
Further collateral history revealed that she had been vacant on a number of occasions for a few minutes. This also involved lip-smacking. She describes a feeling of déjà vu and a feeling of anxiety in her abdomen and chest area immediately prior to these episodes. On a number of these occasions, she seemed to lose track of where she was for some minutes.
Past medical history includes migraines. There is no family history of note. Neurological examination in the clinic is unremarkable.
Investigations:

Haemoglobin 145 g/l 135–175 g/l
White cell count (WCC) 7.2 × 109/l 4–11 × 109/l
Platelets 190 × 109/l 150–400 × 109/l
Sodium (Na+) 142 mmol/l 135–145 mmol/l
Potassium (K+) 4.5 mmol/l 3.5–5.0 mmol/l
Creatinine 90 µmol/l 50–120 µmol/l
CT Head Normal
What is the most likely diagnosis?

MRCP2-3139

An 80-year-old man presented with a history of memory fluctuations and agitation over the past year. He has also been experiencing visual hallucinations. His family became concerned and took him to see his GP, who prescribed haloperidol. However, the medication was recently discontinued as the patient’s condition worsened. Upon examination, the patient exhibited bilateral limb rigidity and bradykinesia, as well as a mild right-sided rest tremor. The rest of the neurological examination was unremarkable. What is the most likely diagnosis?

MRCP2-3140

An 88-year-old lady with a history of Parkinson’s disease and repeated admissions for aspiration pneumonias is admitted to the hospital with symptoms of diarrhoea, vomiting, malaise, stiffness, tremor, fever, and hallucinations. Her current medications include co-beneldopa, warfarin, amlodipine, amitriptyline, metformin, and lactulose. On examination, she is agitated, and a chest x-ray and abdominal examination are unremarkable. Blood tests reveal elevated creatinine, INR, and CRP levels, as well as positive ketones and trace blood in her urine. What would be the most appropriate next step in managing this patient’s condition?

MRCP2-3141

A 35-year-old woman is brought to the Intensive Care Unit after a serious head injury. She meets the requirements for brainstem death and has a registered organ donor card. However, her family is opposed to organ donation.

What is the best course of action in this situation?

MRCP2-3142

A 55-year-old construction worker presents to the hospital after collapsing on the job. He is a smoker of 15 cigarettes per day but has no other medical history. Upon awakening at the construction site, he experienced slurred speech, dizziness, and temporary symptoms on the left side of his body. These symptoms had resolved by the time he arrived at the Emergency Department. Imaging revealed a proximal stenosis of the right subclavian and carotid arteries. EEG results were negative for spike activity. What is the most likely diagnosis based on this clinical presentation?

MRCP2-3143

A 25-year-old woman was brought to the Emergency Room by her sister as she had been exhibiting aggressive behavior and was difficult to handle, both at work and home, for the past few months. She had a habit of touching other people and would occasionally make strange noises and shout obscenities without any reason.
During the examination, she repeatedly blinked her eyes and had involuntary twitches. Other than that, the neurological examination was normal. There were no significant findings on the general physical examination, with a regular pulse of 80 bpm and blood pressure of 120/80 mmHg.
What is the most probable diagnosis?

MRCP2-3144

A 68-year-old woman comes to the clinic complaining of gait ataxia, dysarthria, and dysphagia that have been present for the past 2 years. Upon examination, the patient exhibits downbeating nystagmus and slurred speech. Both upper limbs show past pointing, and the patient has a wide-based ataxic gait. Reflexes and sensation are normal, and there is no wasting or fasciculations. The plantar response is flexor bilaterally. What is the most likely diagnosis?