Archives: MRCP Part 2

MRCP2-2517

A 49-year-old man presented to the emergency department with a history of haematemesis and melaena. There was no previous medical history available. The patient required fluid resuscitation and received eight units of red blood cell transfusion. Upon review after the transfusion, his pulse was 80 beats per minute and blood pressure was 130/78 mmHg. Chest and abdominal examinations were unremarkable. Repeat blood tests were performed and the results are as follows:

– Hemoglobin: 110g/L (normal range: 130-180g/L)
– Platelets: 80 x 10^9/L (normal range: 150-400 x 10^9/L)
– White blood cells: 10 x 10^9/L (normal range: 4.0-11.0 x 10^9/L)
– Prothrombin time: 14.2 seconds (normal range: 11.5-15.5 seconds)
– INR: 1.3 (normal range: <1.4)
– APTT: 32 seconds (normal range: 30-40 seconds)
– Thrombin time: 17 seconds (normal range: 15-19 seconds)
– Fibrinogen: 2.1g/L (normal range: 1.8-5.4g/L)

Based on these results, what blood product should be administered to the patient at this stage?

MRCP2-2518

A 63-year-old man presented to his General Practitioner for routine blood tests. The results showed an erythrocytosis (Packed Cell Volume 0.56) but no other abnormalities. The patient had no symptoms of hyperviscosity, was a non-smoker, and took no regular medications. Further investigations were arranged through haematology clinic, which showed the persistence of erythrocytosis. What is the most appropriate next investigation?

MRCP2-2519

A 25-year-old unmarried male presents with recurrent oesophageal candidiasis. He has a medical history of asthma treated with inhaled steroids and eczema. Laboratory results reveal no B cells and decreased immunoglobulins, normal CD4 T-lymphocyte count, and low platelet count. What is the most likely diagnosis for this patient?

MRCP2-2520

A 20-year-old African male presents to the medical assessment unit with complaints of dark urine, abdominal pain, and jaundice. He has no known co-morbidities and there is no family history of haemolytic anaemias. The patient recently started a new Mediterranean diet that includes fava beans. Upon examination, moderate splenomegaly is noted.

The following laboratory results were obtained:
– Hb: 70 g/l
– Platelets: 280 * 109/l
– WBC: 8.7* 109/l
– Neuts: 5.6 * 109/l
– Lymphs: 1.3 * 109/l
– Eosin: 0.9 * 109/l
– Na+: 137 mmol/l
– K+: 4.3 mmol/l
– Bilirubin: 107 µmol/l
– ALP: 98 u/l
– ALT: 25 u/l
– γGT: 37 u/l
– Creatinine: 77 µmol/l
– Albumin: 35 g/l

Serum haptoglobin was undetectable, and serum lactate dehydrogenase (LDH) was 1987 units/l. Heinz bodies were observed on the peripheral blood film, and a direct Coombs test was negative. G6PD levels were normal.

What is the next investigation that should be performed to confirm the diagnosis?

MRCP2-2521

A 64-year-old woman comes to the haematology clinic with progressive lower back pain and unexplained anaemia. Her initial protein electrophoresis and serum-free light chain assays suggest multiple myeloma. She has a medical history of hypertension and transient ischaemic attacks and takes clopidogrel, amlodipine, and ramipril. What imaging studies should be recommended for further evaluation?

MRCP2-2501

A 32-year-old man with a history of minimal change glomerulonephritis presents at the Emergency Department with a swollen left lower leg. His medication includes ramipril 10 mg daily and furosemide. He recently returned from a flight from France. On examination, he has an obvious left DVT and his BP is 140/80 mmHg. Based on the given investigations, what is the most probable cause of his thrombosis?

MRCP2-2502

A 25-year-old man presents to the general medical clinic with a history of recurrent gallstones and anaemia. He has previously required blood transfusions for his anaemia and was referred to a haematologist but did not attend the appointment. His family history is significant for his mother having jaundice and his estranged father having a blood disorder. On examination, he has conjunctival pallor and a palpable spleen. Blood tests reveal a low Hb, normal platelets and WBC, and elevated MCV and MCHC. Based on these findings, what is the most likely underlying diagnosis?

MRCP2-2503

You are caring for a 36-year-old man who is currently receiving his second round of chemotherapy for a low grade non-Hodgkin’s lymphoma in the oncology day unit. The lymphoma is localized to two lymph node groups in his anterior cervical chain and right inguinal region, with a total of 6 nodes and the largest being 4 cm in size. He experienced no complications during his first round of chemotherapy except for some nausea a week later. He has no other medical conditions and is not taking any other medications. His pre-chemotherapy blood work is as follows:

– Sodium (Na+): 137 mmol/l
– Potassium (K+): 3.8 mmol/l
– Urea: 2.8 mmol/l
– Creatinine: 55 µmol/l
– Corrected Calcium: 2.39 µmol/l
– Phosphate: 1.05 µmol/l

What is the most appropriate regimen to prevent tumor lysis syndrome in this patient’s case?

MRCP2-2504

A 45 year old female patient is admitted to the oncology ward for chemotherapy treatment of Diffuse Large B-Cell lymphoma stage IVb. She had initially visited her GP complaining of intermittent abdominal bloating, constipation, and occasional shortness of breath. Additionally, she reported experiencing drenching sweats that required her to change her bed clothes frequently during the night. Her GP was concerned about these symptoms and immediately arranged for a chest X-ray to be performed at the nearby hospital.

The chest X-ray revealed a large mediastinal mass with clear lung fields, prompting the GP to schedule an urgent appointment with a local haematologist. The patient was seen only four days later, and the hospital team conducted some urgent investigations given her clinical history.

The investigations revealed a Hb level of 9.5 g/dl, platelet count of 140 * 109/l, WBC count of 36.5 * 109/l, and Lactate Dehydrogenase level of 2540IU/l. A CT-guided lymph node biopsy showed large cells with prominent nucleoli and abundant cytoplasm, many mitoses expressing CD19 and CD20 markers. A PET scan revealed large extra-nodal disease bulks, particularly in the ileo-caecal area and mediastinum, indicating bulky disease consistent with advanced stage lymphoma.

The patient was admitted for cycle one of R-CHOP chemotherapy under close monitoring. What electrolyte abnormalities should be monitored to detect tumour lysis syndrome?

MRCP2-2505

A 30-year-old man has been admitted to the haematology ward with a suspected diagnosis of Burkitt’s lymphoma. He received his first dose of chemotherapy today and his blood results have been obtained.

Today’s blood results show elevated levels of creatinine, urea, and phosphate, as well as decreased levels of calcium. Yesterday’s blood results were within normal range.

What urgent treatment is necessary for this patient based on his likely diagnosis?