Archives: MRCP Part 2

MRCP2-2971

A 65-year-old woman presents with a three-month history of diplopia and blurred vision in her left eye. She reports no pain or other neurological symptoms and has no significant medical history except for smoking 20 cigarettes per day and drinking alcohol in moderation.

During her examination, her right eye has a visual acuity of 6/6 while her left eye is only 6/36. She has left partial ptosis and mild proptosis with conjunctival injection. The left pupil is smaller than the right but reacts normally to light. There is some limitation of abduction of the left eye, and fundoscopy reveals a pale left optic disc. The left corneal reflex is reduced, but the remainder of her neurological examination is normal.

Routine blood tests, including a full blood count, urea and electrolytes, liver function tests, thyroid function, serum calcium, serum creatine kinase, and autoantibody screen, were all normal. Her electrocardiogram and chest radiograph showed no abnormalities. Slit lamp examination was normal, and intraocular pressures were within the normal range.

Based on these findings, where is the most likely site of the lesion causing her symptoms?

MRCP2-2972

A 65-year-old man presents with sudden painless diplopia that has been present for the past five days. He reports no weakness in his body and his visual acuity is 6/6 in both eyes according to the Snellen chart. Upon examination, he displays variable horizontal and vertical diplopia in both right and down gaze, as well as bilateral ptosis. The pupils are equal and reactive to light and accommodation, and there is no proptosis or discoloration of the eyes. What is the most likely diagnosis?

MRCP2-2973

A 57-year-old man presents to the clinic with complaints of blurred vision and drooping of his left eyelid for the past three weeks. He has a history of hypertension and hyperlipidaemia, which were diagnosed two years ago, and he currently takes lisinopril and atorvastatin. The patient has been a heavy smoker for the past 30 years.

During the physical examination, the patient’s vital signs are normal, and his pupils and eye movements appear normal. The drooping resolves after closing his eyes for five minutes, but it recurs and worsens progressively after a few minutes. The patient’s cardiovascular, respiratory, and neurological examinations are unremarkable.

What is the most appropriate next step in managing this patient?

MRCP2-2974

A 50-year-old man with a history of type II diabetes mellitus presents for his regular diabetic eye screening. He states that he has been taking his diabetes medications as prescribed. Upon fundoscopy, the following was observed:

What would be the best course of action for managing this patient?

MRCP2-2975

A 72-year-old man comes to the clinic with a sudden painless loss of vision in his left eye. Upon fundoscopy, the following is observed:

What is the probable diagnosis?

MRCP2-2976

A 56-year-old woman with type 2 diabetes mellitus has been referred to the Diabetic Clinic by her GP due to difficulty in reading small print that has gradually developed over several months. She has been managing her diabetes with diet alone for the past 11 years, but is obese and smoking 15 cigarettes a day. Her medical history includes hypertension and hyperlipidaemia, and she takes atenolol 50 mg od. On examination, her blood pressure was 135/85 mmHg and her pulse was 66 bpm and regular. Fundoscopy reveals NPDR. Her FBC and U/Es are normal, and her HbA1c was 63.93 mmol/mol (8.0%). What is the expected outcome if drug treatment is initiated instead of diet management in this patient?

MRCP2-2977

A 65-year-old man presents with visual impairment while on vacation in the United Kingdom. Due to language barriers, obtaining a comprehensive medical history is challenging. However, he appears to be in good overall health and does not exhibit any signs of discomfort. Upon examination, retinal photography is performed and the image is displayed below:

Based on the retinal photography, what is the most probable diagnosis?

MRCP2-2956

A 35-year-old man with type 1 diabetes mellitus presented to the diabetic retinal screening service for the first time. Upon examination, no diabetic retina changes were observed. However, bilateral elevated optic discs with clear borders were noted, and there were no haemorrhages in or around the optic discs. The patient had 6/6 visual acuity in both eyes. What is the most appropriate test to confirm the diagnosis?

MRCP2-2961

An 80-year-old man with a lengthy history of visual problems due to bilateral glaucoma is brought to the GP by his son. The son is worried as his father has become very obstinate and is insisting that he sees colors and patterns on the wallpaper that are not really there, and even claims to see animals and buildings outside the window. The patient has no other significant medical history, but admits to drinking a glass of wine per night. During examination, his blood pressure is 136/84 mmHg, his heart rate is 70 bpm, and he has atrial fibrillation. Visual acuity testing reveals that he is blind, but his mini-mental state testing is normal. What is the most probable diagnosis?

MRCP2-2962

A 42-year-old man has been experiencing left-sided orbital pain for the past three weeks. The pain is particularly severe in the evenings, especially when he is reading, and he has noticed a halo around lights at this time. He also experiences headaches on the same side as the orbital pain, which usually resolve when he goes to bed. However, over the past day, he has noticed a significant deterioration in his vision in the left eye.

During examination, his blood pressure is 130/80 mmHg, his pulse is 80/min and regular. His visual acuity is 6/6 in the right eye, but he can only see hand movements in the left eye. There is corneal and scleral injection on the left.

What is the most likely diagnosis for this patient?