Archives: MRCP Part 2

MRCP2-4770

A 42-year-old man presents with pain in his left elbow when extending his forearm and wrist. He is an avid tennis player and has been playing more frequently lately. Despite taking NSAIDs and resting for the past 4 weeks, his pain has not improved and he has a tournament coming up in 2 weeks.

During examination, the elbow is slightly flexed and there is tenderness over the lateral epicondyle. Resisted wrist extension also reproduces his pain.

What would be the most appropriate intervention to provide short term relief for this patient?

MRCP2-4771

A 65-year-old woman has been referred to the Rheumatology Clinic after experiencing her second Colles’ fracture. DEXA scanning confirms osteoporosis with a T-score of -2.8. The patient is eager to begin preventive treatment.
Based on the following investigations, which initial therapy would be the most appropriate for this patient?

Investigation Result Normal Value
Phosphate (PO43-) 0.9 mmol/l 0.70–1.40 mmol/l
Corrected Calcium (Ca2+) 2.27 mmol/l 2.20–2.60 mmol/l
Alkaline phosphatase (ALP) 180 IU/l 30–130 IU/l
Urea 3.2 mmol/l 2.5–6.5 mmol/l
Creatinine (Cr) 75 µmol/l 50–120 µmol/l
Potassium (K+) 4.2 mmol/l 3.5–5.0 mmol/l
Sodium (Na+) 140 mmol/l 135–145 mmol/l

MRCP2-4773

A 42-year-old man presents with severe pain and aching in his hands and feet upon exposure to cold temperatures. He describes a triad of initial whitening of the fingers due to vasospasm, followed by blue discoloration and then reddening and pain.
The patient is currently on atenolol 50 mg po daily for hypertension and takes sumatriptan for occasional migraines. He has a history of chronic kidney disease with a creatinine level of 200 μg/l. The sumatriptan is discontinued.
What other intervention would be the most appropriate for this individual?

MRCP2-4774

A 28-year-old woman visits her primary care physician after returning from a 2-week trip to India. She reports discomfort while urinating and occasionally passing cloudy urine resembling pus. Additionally, she experiences joint pain, particularly in her knees and ankles, and itchy eyes. During the examination, a psoriasis-like rash is observed on her hands.
Based on the probable diagnosis, which of the following treatments would be most appropriate for managing this condition?

MRCP2-4775

A local GP requests your evaluation of a 40-year-old female patient who has been experiencing symptoms of oesophageal reflux disease that have only partially responded to proton-pump inhibitors. Lately, she has been complaining about the cold weather and may have Raynaud’s phenomenon. During routine blood testing, her creatinine levels were found to be elevated at 180 µmol/l, and she has hypertension with a blood pressure reading of 170/85 mmHg. What is the most effective treatment to prevent further renal impairment?

MRCP2-4777

A 36-year-old man is referred to the Rheumatology Department with recurrent sinusitis. He also has chronic joint pain and overall fatigue.
Blood testing reveals urea of 13.8 mmol/l and creatinine of 320 µmol/l.
Which of the following findings would most likely support the suspected diagnosis of Granulomatosis with polyangiitis?

MRCP2-4778

A 57-year-old male presents with gradual onset bilateral tinnitus over the past 3 months, along with worsening hearing, intermittent headache, and increasing lower limb edema. He denies diplopia, vertigo, dysphagia, or dysarthria, as well as any urinary symptoms or weight loss. The patient has a past medical history of hypertension and insulin-dependent diabetes, and reports a family history of prostate carcinoma with both his father and uncle previously undergoing resections. On examination, cranial nerves are unremarkable except for bilateral hearing loss, and there is no limb weakness but significant spinal kyphosis. Heart sounds I and II are heard with no added sounds, and bibasal crackles are auscultated. His abdomen is soft and non-tender. Initial serum markers show platelets at 264 * 109/l, WBC at 9 * 109/l, and Neuts at 5.4 * 109/l, with Na+ at 142 mmol/l, K+ at 4.3 mmol/l, urea at 7.8 mmol/l, creatinine at 90 µmol/l, bilirubin at 6 µmol/l, ALP at 902 u/l, and ALT at 28 u/l, and CRP at 16 mg/l. Parathyroid hormone and vitamin D are within normal range. What other biochemical marker will be abnormal?

MRCP2-4779

A 63-year-old woman presents to her GP with increasing shoulder pain and stiffness, which is worse in the morning and improves throughout the day. She has been taking ibuprofen for relief. She has no history of headaches or visual symptoms and denies recent injury. Her medical history includes hypertension, treated with amlodipine 10 mg daily.

During the examination, her vital signs are normal, and her chest and heart sounds are unremarkable. Her abdomen is soft and non-tender. She has bilateral shoulder and hip pain with limited range of motion. There are no skin rashes or discoloration. Based on these findings, what feature is most likely to be present in her diagnosis?

MRCP2-4780

A 56-year-old man presents with a history of malaise and fever for several months. He complains of intermittent swelling and pain in his left ear, painful red eyes, and arthralgia. He has no past medical history and is not taking any regular medications.

During the examination, you observe left auricular swelling, bilateral anterior uveitis, and symmetrical small joint polyarthritis.

Lab results show Hb 115 g/l, Na+ 138 mmol/l, platelets 330 * 109/l, K+ 4.2 mmol/l, WBC 13.1 * 109/l, urea 6.2 mmol/l, neuts 10.4 * 109/l, creatinine 95 µmol/l, lymphs 2.5 * 109/l, CRP 132 mg/l, eosin 0.6 * 109/l, pANCA negative, C3 normal, C4 normal, ANA negative, Anti Sm negative, RhF positive, and Anti CCP negative.

What is the most likely diagnosis?

MRCP2-4781

A 60-year-old Asian woman presents to the Rheumatology Clinic with chronic joint issues. She reports initial involvement of the small joints in her hands, which resolved after a few weeks, but now her wrists, elbows, and knees are primarily affected. She has a history of recurrent ear infections and nasal septum inflammation, for which she received antibiotics and pain relief. Her family has a history of systemic lupus erythematosus, and she takes amlodipine for hypertension. On examination, her wrists and knees are swollen and tender with limited movement, and her nose is saddle-shaped with red and tender right upper ear cartilage. Lab results show low hemoglobin, high white cell count and erythrocyte sedimentation rate, and slightly elevated creatinine. Rheumatoid factor and antinuclear antibody tests are negative, and urine dipstick is normal. What is the most probable diagnosis?