Archives: MRCP Part 2

MRCP2-2486

A 32-year-old Hispanic man visits a new GP to discuss the results of some blood tests ordered by his previous doctor. During his last check-up, he mentioned feeling excessively tired and fatigued. His physical exam revealed splenomegaly. Further testing showed elevated basophils and eosinophils, as well as poikilocytes and normoblasts on his blood film. The following results were obtained:
Test Result Normal Range
Hemoglobin (Hb) 112 g/l 130–170 g/l
White blood cell count (WBC) 42.0 × 109/l 4.5–11.0 × 109/l
Platelets (PLT) 95 × 109/l 150–450 × 109/l
What diagnosis could explain these findings?

MRCP2-2487

A 49-year-old man presents with dysuria and a low grade fever. He is prescribed a course of Nitrofurantoin for a suspected urinary tract infection. He has a history of ischaemic heart disease for which he takes aspirin and atorvastatin.

The next day, he notices that his urine has become very dark and he feels breathless and more unwell. Blood tests reveal a low hemoglobin level, high white blood cell count, and the presence of Heinz bodies on blood film microscopy.

What is the underlying diagnosis for this patient’s symptoms and abnormal blood results?

MRCP2-2488

A 55-year-old man presents to the emergency department with fatigue and bruising. Upon examination, hepatosplenomegaly is observed, but no peripheral lymphadenopathy is palpable. The patient’s blood tests reveal the following results:

– Hemoglobin: 73 g/L
– Platelets: 43 * 10^9/L
– White blood cells: 2.3 * 10^9/L
– Neutrophils: 0.8 * 10^9/L
– Lymphocytes: 1.3 * 10^9/L
– Monocytes: 0.0 * 10^9/L
– Basophils: 0.02 * 10^9/L
– Eosinophils: 0.1 * 10^9/L

After diagnosis, it is determined that the patient has hairy cell leukemia. What gene is mutated in this malignant condition?

MRCP2-2489

A 54-year-old woman presents to her GP with a complaint of galactorrhoea that has been ongoing for a few months. She has a medical history of chronic kidney disease (requiring peritoneal dialysis), previously treated hyperthyroidism (stopped 2 years ago), and Raynaud’s syndrome for which she takes nifedipine. The GP orders a blood test which reveals hyperprolactinaemia (1250 mu/l). What is the most probable cause of hyperprolactinaemia in this patient?

MRCP2-2490

A 46-year-old man is brought to the emergency department from a local park. He is in respiratory distress with a ventilatory rate of 32 breaths per minute and a peripheral oxygen saturation of 88% on 15 L/min oxygen via a non-rebreather mask. He appears pale and diaphoretic with central cyanosis. His heart rate is 120 bpm and blood pressure is 96/68 mmHg. Upon chest examination, there are no significant findings and there is no clinical indication of heart failure. A chest x-ray reveals no acute pathological lesion but shows emphysematous changes in the background. An ECG shows only sinus tachycardia with a corrected QT interval approaching the upper limit of normal with no ischaemic lesions.

An arterial blood gas taken on 15 L/min oxygen shows:

pH 7.17 HCO3- 13.4 Glucose 6.9 mmol/l MetHb 35%
pO2 10.9 Base excess -5.8 Potassium 5.5 mmol/l COHb 8%
pCO2 6.7 Lactate 4.1 mmol/l

The patient is starting to exhibit signs of exhaustion and confusion, and his GCS has decreased to 13/15 (E3V4M6). He admits to inhaling Liquid Gold (an alkyl nitrite).

What is the most appropriate immediate intervention for this patient’s management?

MRCP2-2491

A 26-year-old male presents with dyspnea. Upon examination, his respiratory rate is 36 breaths per minute and heart rate is 130 beats per minute. His blood pressure is 118/82 mmHg. An SpO2 reading is 85%. He appears cyanotic. He has a medical history of coeliac disease, dermatitis herpetiformis, rheumatoid arthritis, and asthma. He takes dapsone, prednisolone, paracetamol, and ibuprofen regularly. He recently finished a course of amoxicillin for a chest infection.

An arterial blood gas test is conducted (on 15 liters of O2):

Hb 125 g/l
pH 7.33
PaO2 58.11 kPa
PaCO2 2.48 kPa
SO2 99.7%
HCO3 12 mmol/l

Which medication is the most likely cause of his symptoms?

MRCP2-2492

A 45-year-old woman of Mediterranean descent presents with fatigue and is found to be anaemic. She has a past medical history of well-controlled hypothyroidism and hypertension. Her blood tests show low Hb and MCV levels, high ferritin levels, and low folate and B12 levels. Which diagnostic test is most likely to reveal the underlying cause of her anaemia?

MRCP2-2493

A man aged 63 years is referred to the Haematology Clinic for assessment. His GP conducted a routine blood test which showed an elevated ESR (90 mm/h) and an increased IgG paraprotein band (2.1 g/l). No urinary light chain excretion was detected. Despite being well three years later, he still has an elevated ESR and IgG paraprotein band, with no urinary light chain excretion. What is the most appropriate diagnosis for this clinical presentation?

MRCP2-2494

A 67-year-old man is admitted with dehydration following an attack of infectious gastritis. His initial blood results revealed a raised calcium and erythrocyte sedimentation rate. He has a history of hypertension, angina, chronic obstructive airways disease and diabetes. His most recent results arrive on the ward and reveal the following:
Haemoglobin (Hb) 138 g/l 135–175 g/l
White cell count (WCC) 7.7 × 109/l 4.0–11.0 × 109/l
Platelets (PLT) 212 × 109/l 150–400 × 109/l
Sodium (Na+) 138 mmol/l 135–145 mmol/l
Potassium (K+) 4.7 mmol/l 3.5–5.0 mmol/l
Creatinine (Cr) 104 µmol/l 50–120 µmol/l
Urea 7.2 mmol/l 2.5–6.5 mmol/l
Corrected calcium (Ca2+) 2.4 mmol/l 2.20–2.60 mmol/l
Albumin 38 g/l 35–55 g/l
Immunoglobulin G (IgG) 19 g/l (monoclonal band identified) 5–16 g/l
IgA 2.1 g/l 1.0–4.0 g/l
IgM 1.3 g/l 0.5–2.0 g/l
Urine, Bence Jones protein –
Chest X-ray (CXR) Heart and mediastinal contours normal, lungs clear, osteopenia of bony skeleton with no lytic lesions
What is the most probable diagnosis?

MRCP2-2495

A 76-year-old woman presents to the medical assessment unit with diffuse bone pain affecting her back and ribs for the past two months. She has no significant medical history and is not taking any regular medications. Despite her age, she still works as a potter and does not smoke.

Upon clinical examination, there are no focal areas of tenderness or swelling, and no organomegaly or lymphadenopathy. Cardio-respiratory examination is unremarkable.

The following blood tests were conducted: Hb 111 g/L (female: 115-160), platelets 389 * 109/L (150-400), WBC 4.2 * 109/L (4.0-11.0), Na+ 138 mmol/L (135-145), K+ 4.2 mmol/L (3.5-5.0), urea 4.8 mmol/L (2.0-7.0), creatinine 88 µmol/L (55-120), CRP 10 mg/L (<5), calcium 2.68 mmol/L (2.20-2.60), immunoglobulin G 24.1 g/L (6.6-15.9), immunoglobulin A 4.4 g/L (0.6-5), and immunoglobulin M 2.2 g/L (0.53-2.47). Serum protein electrophoresis revealed the presence of a paraprotein. What is the recommended first-line imaging investigation for this likely diagnosis?