Archives: MRCP Part 2

MRCP2-3058

A 58-year-old male construction worker presents with sudden and severe lower back pain. He has no history of orthopedic issues and has been in good health until now. The patient reports experiencing tingling sensations in his lower limbs and has not been able to urinate since the onset of the pain. Upon neurological examination, weakness (3/5 of both lower limbs) and loss of sensation to touch in L4, L5, and S1 are observed. Vibration sensation and joint position sensation are intact, but reflexes in the ankles and knees are absent and the plantar response is uncertain. The patient’s blood pressure is 160/70 in his left arm and 152/64 in his right, heart rate is 96 bpm, temperature is 37°C, and ECG shows normal sinus rhythm with no signs of ischemia. The rest of the examination is unremarkable. What diagnostic test would be most helpful in determining the cause of the patient’s symptoms?

MRCP2-3059

A 26-year-old male patient complains of abrupt onset of pain on the right side of his neck, accompanied by pain behind his right eye. After 12 hours, he experiences right ptosis and miosis of his right pupil, along with left-sided weakness and facial drooping. What could be the probable cause of his stroke?

MRCP2-3060

A 28-year-old male patient complains of nasal congestion for the past six months. An ENT specialist previously diagnosed him with sinusitis. However, he returns with a new symptom of right periorbital swelling and double vision that started two days ago. Upon examination, the patient appears unwell with a temperature of 37.4°C. Although he does not have neck stiffness or photophobia, his right eyelid droops significantly, and his right eye is congested and deviated to the right with an enlarged pupil. The left eye appears normal, and fundoscopy shows no abnormalities. Additionally, the patient experiences a loss of sensation in the right forehead. What is the most likely diagnosis?

MRCP2-3061

A 26 year-old man with ataxia telangiectasia undergoes open biopsy of an enlarged axillary lymph node. Microscopic examination reveals changes consistent with nodular sclerosing Hodgkin’s disease. Regrettably, he develops spreading cellulitis around the biopsy site which does not improve with intravenous antibiotics and ultimately necessitates surgical debridement.

What is the primary cause for the heightened vulnerability to infections in individuals with ataxia telangiectasia?

MRCP2-3062

A 55-year-old woman is brought to the hospital after collapsing suddenly, with a severe headache preceding the incident. Upon arrival at the Emergency Department, her Glasgow Coma Scale (GCS) has improved to 13, and a CT scan confirms a subarachnoid hemorrhage.

You are summoned to assess her 72 hours after admission because her GCS has progressively declined to 8 over the past hour. She is currently breathing air, and her SpO2 is at 97%.

What is the most probable cause of this secondary deterioration?

MRCP2-3036

A 32 year-old male patient complains of gradual onset weakness in his right hand for the past week. Being right hand dominant, he is finding it difficult to perform simple tasks like unlocking a door with a key.

Upon examination, he displays significant weakness in flexing his thumb at the interphalangeal joint and flexion of the index and middle finger. No sensory deficit is detected.

What is the probable diagnosis?

MRCP2-3041

A 45-year-old woman presents with a six-week history of brief episodes where she feels like the room is spinning around her. These episodes are most severe when she lies on her right side with her ear down and are accompanied by nausea. She reports no issues with hearing or tinnitus. On examination, she exhibits rotatory nystagmus that begins several seconds after assuming the right lateral decubitus position and resolves after a minute. Repeated positioning in the same position results in the attenuation of the nystagmus. Audiometry testing shows normal hearing. What is the likely diagnosis for this patient?

MRCP2-3042

A 65-year-old woman presents with paroxysmal dizziness characterized by episodes of room spinning. The symptoms worsen when she rolls over to the right in bed or reaches above her head. She reports no other symptoms. Upon neurological and general medical examination, no abnormalities are found. The vertigo can be induced by turning the patient’s head 45 degrees to the right and then moving them to a supine position. Nystagmus (upbeating and torsional) is present for only a few seconds. What is the diagnosis?

MRCP2-3043

A 25-year-old medical student is being evaluated for severe headache and stiffness in the neck. The on-call doctors have recommended an LP after a normal CT scan, but the patient is concerned about developing a post-lumbar puncture headache. What technique has been demonstrated to decrease the occurrence of this type of headache and would be appropriate for this patient?

MRCP2-3044

A 32-year-old man presented with gradual difficulty walking and blurry vision over the course of 3 weeks. The day before admission he became excessively sleepy, but still able to be awakened. His partner reported that he had been healthy except for a recent viral illness a month ago.

During the examination, he appeared slightly disoriented and drowsy. His vital signs were normal and there were no abnormalities found during cardiovascular, respiratory, or abdominal examinations. He had reduced upward gaze and bilateral abduction, but all other cranial nerves were normal. His limb examination was unremarkable except for brisk reflexes and up-going plantars.

What is the most probable diagnosis?