Archives: MRCP Part 2

MRCP2-4594

A 32-year-old female intravenous drug user presents to the Emergency Department with a purplish rash on her arms and feet that has been progressively worsening for the past 2 weeks. The rash is not painful or itchy. Upon examination, she appears to be in mild distress and has mild jaundice. Her heart and lungs are normal, but there is tenderness in the right upper quadrant of her abdomen, and her liver edge is palpable 4 cm below the right costal margin. The skin examination reveals palpable purpura on both arms and her left foot, and her right lower limb has erythematous nodules and livedo reticularis. The CNS examination shows decreased strength in plantar flexion and decreased sensation in the left foot. Laboratory results show that she is HIV negative and hepatitis B surface antigen positive. Urine microscopy reveals the presence of red blood cells and protein, but no white blood cells. What is the most likely cause of her rash?

MRCP2-4599

A 68-year-old woman presents to her GP with a 2-week history of progressive shoulder pain. She reports difficulty getting dressed in the morning due to the pain. She also feels weak and fatigued and has lost around 2 kg in weight. There is no significant medical history. On examination, she has a temperature of 37.8 °C, heart rate of 90 bpm, and blood pressure of 127/77 mmHg. Heart sounds are normal, and breath sounds are vesicular bilaterally. Abdomen is soft and non-tender with no palpable organomegaly. Bilateral proximal muscle stiffness is noted. What is the most likely diagnosis?

MRCP2-4590

An 89-year-old male is admitted to hospital after recurrent mechanical falls. His past medical history includes an anterior resection for sigmoid carcinoma, type 2 diabetes mellitus and gout.

Three days into his admission, he was treated for hospital-acquired pneumonia with three days of intravenous tazocin. One week into his admission, he developed a swollen inflamed 2nd MTP joint and colchicine was started.

After becoming medically stable 10 days into admission and awaiting a package of care at home, nursing staff report diarrhoea, with type 7 stool up to 7 times a day. He has no laxatives prescribed. One set of stool cultures were sent within 15 minutes of the last episode, which have proved negative for Clostridium difficile toxin and, MC+S and norovirus.

What is the most likely cause of his diarrhoea?

MRCP2-4593

A 53-year-old man presents to the Emergency Department with severe knee pain and swelling, particularly in his right knee, which has limited flexion to around 30 degrees. He is a bar owner in Tenerife and admits to drinking up to 10 units of alcohol per day. His Spanish general practitioner has recently recommended he follow a diabetic diet. On examination, he has truncal obesity with a BMI of 33 kg/m2, a blood pressure of 155/95 mmHg, and a pulse of 80 bpm and regular. His investigations reveal a raised CRP of 42 mg/l, Hb of 134 g/l, WCC of 8.0 × 109/l, PLT of 200 × 109/l, Na+ of 137 mmol/l, K+ of 4.3 mmol/l, Cr of 110 µmol/l, glucose of 10.9 mmol/l, ALT of 122 IU/l, ALP of 95 IU/l, ferritin of 630 µg/l, and urate of 0.43 mmol/l. What is the most likely diagnosis?

MRCP2-4589

A 56-year-old woman with a 3-year history of rheumatoid arthritis presents with joint pain and numbness in her hands. She is currently taking methotrexate 20 mg per week. The pain is worse in the mornings and she experiences intermittent paraesthesia that wakes her up at night. On examination, there is mild swelling and tenderness over the small joints of the hands and wrists, but no neurological deficits are noted. Her laboratory results show a low hemoglobin level, elevated white cell count, elevated platelets, and elevated ESR and CRP. What would be the most appropriate next step in her evaluation?

MRCP2-4591

A 59-year-old man is experiencing difficulty with stairs, chairs, and reaching for items on shelves. Upon examination, his proximal power is 4/5 with intact reflexes and downward going plantars. Recent blood tests show abnormal levels of Hb, WBC, neutrophils, platelets, ESR, CK, and CRP. Additionally, he tested positive for anti-nuclear antibodies. What is the diagnosis?

MRCP2-4598

A 70-year-old man with a history of chronic lymphocytic leukaemia presents to the Emergency Department with worsening proximal myopathy and bone pain in his arms and legs. Laboratory results show significantly low levels of phosphate, and urine testing reveals the presence of glycosuria despite normal serum glucose levels. What is the most likely diagnosis for this patient’s symptoms?

MRCP2-4595

A 35-year-old woman presents with pain in her right ankle that she has been experiencing for the past 3 weeks. A few days later, she notices that the ankle is also swollen. A week later, she develops pain and swelling in both knees. Her GP prescribed diclofenac 50 mg three times daily, which provided some relief. She recalls having loose bowel movements for a few days about 2 weeks before the onset of joint symptoms. She mentions that she sometimes experiences loose bowel movements after eating takeout. What is the most likely diagnosis based on her symptoms and the provided investigations?

MRCP2-4597

A 46-year-old woman presents to the Endocrine Clinic with complaints of bone pain and weakness. She reports difficulty getting up and has noticed a progressive decline in her strength. Her diet consists mainly of minimally processed seeds and beans. On examination, she has 3/5 power in shoulder abduction and adduction, and 3/5 power in hip flexion and extension. Her plantar reflexes are flexor. Laboratory investigations reveal abnormal levels of alkaline phosphatase, phosphate, and corrected calcium. Based on this clinical picture, what is the most likely underlying cause of her symptoms?

MRCP2-4596

A 65-year-old woman presents with a one-week history of fever, chills, nausea, vomiting, and joint pain. Her GP prescribed a five-day course of amoxicillin with no improvement. She has osteoarthritis and complains of severe use-related pain in her distal interphalangeal joints and knees, with no previous swelling. She denies cough, sore throat, or dysuria. Her medical history includes diabetes mellitus, hypertension, coronary artery disease, and gout. On examination, she is acutely unwell, with a temperature of 39.8°C, pulse of 96 beats/min, and BP of 190/100 mmHg. Investigations show mild cardiomegaly on chest x-ray, and blood cultures and urinalysis are negative. Which investigation should be performed next?