Archives: MRCP Part 2

MRCP2-2978

A 70-year-old man presented to the optician with a gradual decline in vision and a headache. Upon examination, the optician noticed concerning fundoscopic appearance and referred him to the emergency department for further evaluation. The patient has a history of hypertension and diabetes, but reports good adherence to his medications including perindopril, amlodipine, hydrochlorothiazide, metformin, linagliptin, and dapagliflozin.

What would be the most appropriate next step in managing this patient?

MRCP2-2980

A 20-year-old college student presents to the general medical clinic with bilateral ptosis that has gradually developed over the past few months. He reports having to tilt his head upwards during lectures due to the severity of his symptoms. He denies any changes in his symptoms throughout the day.

The patient has no significant medical history and is not taking any regular medications. He mentions that his mother had a pacemaker implanted due to frequent episodes of fainting.

Upon examination, bilateral ptosis is noted, along with impaired abduction and adduction of both eyes. Direct fundoscopy reveals black spicules in the periphery of both eyes. An ECG is performed and shows sinus rhythm with first-degree heart block.

Based on the likely diagnosis, which additional symptom is the patient most likely to report?

MRCP2-2981

A 43-year-old man presents with partial left Horner’s syndrome, neck pain, and decreased vision on the same side. His initial CT scan shows gliosis in the left frontal area. What diagnostic test would be most helpful in determining the cause of his symptoms?

MRCP2-2982

A 42-year-old woman comes to the emergency department with a 3-week history of worsening headaches. She reports experiencing occasional bouts of dizziness and double vision. The patient has a medical history of borderline type 2 diabetes and is currently taking metformin and the combined contraceptive pill.

During the examination, the patient’s vital signs are normal, and there are no noticeable neurological deficits. A fundoscopy is performed, revealing the following image:

Based on the fundoscopy results, what is the next course of action for managing this patient?

MRCP2-2983

A 58-year-old woman comes to the emergency eye unit with a sudden loss of vision in her left eye that started a day ago. She has no history of vision problems or pain. Her medical history includes hypertension and type 2 diabetes, which are managed with ramipril and metformin, respectively.

During the examination, her left eye’s visual acuity is reduced, and she can only see hand movements. However, her right eye’s visual acuity remains unchanged at 6/9. The fundoscopic examination of her left eye is shown below:

Based on the information provided, what is the most likely diagnosis?

MRCP2-2984

A 65-year-old woman comes to the emergency department with a sudden painless loss of vision in the left eye. Upon examination, there is a decrease in visual acuity in the left eye.

The fundoscopy reveals:

Based on the fundoscopy results, what is the probable diagnosis?

MRCP2-2985

A 22-year-old Caucasian female presents to eye casualty with sudden onset blurred vision in her left eye. She reports noticing it about 12 days ago and reports progressive deterioration associated with pain on eye movement until her presentation today. There is a vague history of a possible ‘cough and cold’ about 4 weeks ago but she has reported no other recent illnesses. She has no past medical history, is on the oral contraceptive pill and has no other medications. There is no smoking, alcohol or recreational drug history.

Upon examination, visual acuity and colour vision on Ishihara plates were noted to be 6/6 and 17/17 plates in her right eye, 6/24 and 0/17 plates in her left eye. A left relative afferent pupillary defect was demonstrated, fundoscopy was unremarkable. Examination of her other cranial nerves and limbs were unremarkable. Her blood tests were unremarkable and she has declined a lumbar puncture. An MRI head and whole spine demonstrates no abnormalities except for a swollen left optic nerve is visualised. What is the most appropriate treatment?

MRCP2-2986

A 36-year-old man comes to the emergency department complaining of sudden onset severe pain in his right eye, along with photophobia and decreased vision. He has no history of similar episodes and occasionally takes codeine for back pain.

Upon examination, the right eye appears diffusely red and the pupil is smaller than the left. The patient is unable to count fingers in the affected eye, while visual acuity in the left eye is normal.

What is the probable diagnosis?

MRCP2-2987

A 39-year-old man with severe ulcerative colitis visits his GP complaining of a red left eye that has developed over the past 24 hours. He is experiencing discomfort when moving his eye in any direction but reports no changes in his vision. On examination, his right eye appears normal, while his left eye is watery, erythematous, and has asymmetric miosis. He requests that the lights be dimmed during the examination as they are causing discomfort.

What is the most appropriate treatment for this man’s red eye?

MRCP2-2988

A 55-year-old woman comes to the optician complaining of a gradual decrease in her visual acuity. Upon examination, the optician refers her for medical evaluation. The fundoscopic exam reveals:

Based on the fundoscopic findings, what is the most suitable course of treatment?