Archives: MRCP Part 2

MRCP2-2951

A 56-year-old woman presents to the Emergency Department with a four hour history of headache and visual disturbance. She reports that the headache came on suddenly and she has vomited several times since the pain started. She has no significant medical history and wears glasses for reading.

During examination, a mid-dilated pupil is observed in the left eye. The right eye direct pupillary reaction was satisfactory. There is no tenderness over the left temporal artery and no other neurological deficit is noted.

Her vital signs are as follows: blood pressure of 142/92 mmHg, heart rate 88 bpm, temperature 36.5ºC, oxygen saturation 97% on room air, and respiratory rate 14/min.

The following blood results were obtained:

– Hb 138 g/L (Female: 115 – 160)
– Platelets 420 * 109/L (150 – 400)
– WBC 10.5 * 109/L (4.0 – 11.0)
– Na+ 137 mmol/L (135 – 145)
– K+ 4.2 mmol/L (3.5 – 5.0)
– Urea 4.8 mmol/L (2.0 – 7.0)
– Creatinine 75 µmol/L (55 – 120)
– CRP 7 mg/L (< 5) In addition to topical pilocarpine, what other medication should be urgently administered to manage this condition?

MRCP2-2952

A 50-year-old woman arrives at the emergency department complaining of severe pain in her left eye. She states that the pain began about 2 hours ago and has not subsided despite taking paracetamol. The patient is farsighted and wears daily contact lenses. She has no significant medical history.

During the examination, her left eye has a visual acuity of 6/9, while her right eye has a visual acuity of 6/60. The following image shows the results of the eye examination:

What is the recommended course of action for managing this patient?

MRCP2-2953

The emergency department registrar seeks your guidance on the initial treatment for a 68-year-old female patient who has arrived with a severely painful right eye. During examination, it was observed that the right pupil is fixed in mid-dilation and unresponsive to light. The conjunctiva appears inflamed, and the patient is experiencing significant discomfort, having vomited twice in the department. The emergency department physicians have administered intravenous analgesia and anti-emetics. Urgent referral to ophthalmology has been made.

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?

MRCP2-2957

A 50-year-old man with a history of asthma presented with bilateral blurry vision that had gradually developed over the past two months. Upon examination, he was diagnosed with bilateral posterior subcapsular cataract, with the right eye being more affected than the left. The patient had a history of galactosaemia in infancy, which had been treated. He was currently taking bronchodilator and steroid inhalers for his asthma, as well as long-term prednisolone, amiodarone, aspirin, and simvastatin. What is the most likely cause of his cataracts?

MRCP2-2958

A 32-year-old female presents to the Emergency Department with deteriorating vision in her right eye. She reports a gradual decline in visual acuity since waking up this morning and can now only perceive light and dark on the right side. On examination, a crusted papular lesion is noted on the back of her right hand, which she attributes to a scratch from some stray cats she encountered a few days ago. Additionally, there is lymphadenopathy in her right axilla. Fundoscopy of the right retina reveals cotton wool spots and haemorrhages. Her blood pressure measures 130/80 mmHg. What is the probable cause of her visual impairment?

MRCP2-2959

A 54-year-old woman presents to the emergency department with a complaint of decreased vision in her left eye upon waking up this morning. She reports feeling generally well and has no pain. Her medical history is significant for polymyalgia rheumatica, which she manages with 2.5 mg prednisolone daily. On examination, her right eye has a Snellen visual acuity of 6/9, while her left eye has a visual acuity of 6/36 with diffuse optic disc swelling and a pale fundus. What is the most likely diagnosis for her visual loss?

MRCP2-2960

A 72-year-old man presents to the Ophthalmology Clinic after being involved in a car accident and having poor visual acuity. He reports difficulty with driving due to poor distance perception and recognizing faces of friends in the supermarket over the past few months. He has a medical history of hypertension managed with lisinopril and indapamide. His blood pressure is 155/90 mmHg, and his pulse is 80 bpm and regular. Fundoscopy reveals significant bilateral optic nerve drusen and areas of geographic atrophy in both eyes. What is the most likely 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?