Archives: MRCP Part 2

MRCP2-2474

A 35-year-old man presents to his primary care physician with persistent heartburn for the past six weeks. He has no known medical conditions and is not taking any medications. Upon examination, there are no notable findings. An endoscopy is performed, revealing gastritis. Biopsies of the stomach confirm the presence of a low-grade mucosa-associated lymphoid tissue lymphoma (MALToma/marginal zone lymphoma), with no evidence of Helicobacter pylori. A CT scan of the chest, abdomen, and pelvis shows no signs of additional disease, and a bone marrow biopsy is normal. The thickness of the stomach wall is not clearly visible.
What is the next step in managing this patient?

MRCP2-2475

An 88-year-old man is currently hospitalized for pneumonia and is taking apixaban for atrial fibrillation. He has also been receiving intravenous ampicillin since admission two days ago. Unfortunately, he falls and sustains a head injury, resulting in a subdural haemorrhage and midline shift on CT scan. What is the best course of action for management?

MRCP2-2476

You are requested to evaluate a 50-year-old man who has been diagnosed with low-risk myelodysplasia for the past six years. He has been receiving regular transfusions and has received more than 35 documented red cell concentrate transfusions. Despite his stable haemoglobin levels in the range of 80-90 g/L, he is asymptomatic. His ferritin level is found to be 2500 µg/L. What would be the most appropriate course of action in this case?

MRCP2-2477

A 30-year-old woman with sickle cell disease presents to the hospital with recurrent bone pain following a recent respiratory infection. She expresses a desire for a treatment that can reduce the frequency of hospital admissions for these painful episodes.

What is the most suitable course of action for this patient?

MRCP2-2478

A 25-year-old woman presents with sudden onset right-sided weakness of 24 h duration. She has sickle cell disease and has been hospitalized in the past for chest crises. She takes ibuprofen for pain as needed, penicillin V, and folic acid. She smokes five cigarettes daily and drinks 14 units of alcohol per week. Her parents are both carriers for HbS, and she has no siblings or children.

During the examination, she has dense, right-sided weakness, with brisk reflexes and upgoing plantars on the right-hand side. A CT scan of the brain confirms a left-sided hypodense lesion. Her Hb is 105 g/l.

What is the most appropriate short-term intervention?

MRCP2-2479

A 25-year-old woman is being investigated for frequent nosebleeds. She has noticed increased bruising and has suffered from heavy menstrual bleeding since her teenage years. A recent tooth extraction resulted in prolonged bleeding which required evaluation in the local Emergency Department. She reports a family history of bleeding disorders.

Based on the investigations, what initial treatment would be recommended if she needs further dental procedures?

Haemoglobin 130 g/l 120-160 g/l
White cell count (WCC) 6.5 × 109/l 4-11 × 109/l
Platelets 400 × 109/l 150-400 × 109/l
Activated partial thromboplastin time 40 s 23.0-35.0 s
Prothrombin test 13 s 10.6-14.9 s
Bleeding time 9 min 3-8 min
Factor VIII level 55 IU/dl 50-150 IU/dl

MRCP2-2480

A 65-year-old male undergoing chemotherapy treatment with mitomycin for bladder cancer presents to the Emergency Department with confusion, epistaxis and a widespread rash. On examination, he is febrile and has a diffuse petechial rash.

Hb 10.6g/dl
Platelets 54 * 109/l
WBC 11.2 * 109/l
Urea 11 mmol/l
Creatinine 117µmol/l
Bilirubin 58µmol/l
ALP 42u/l

A blood film shows fragmented erythrocytes.

What is the most appropriate treatment for this patient?

MRCP2-2481

A 38-year-old man presents with stage IV diffuse large B cell lymphoma. On the CT scan, he has bulky abdominal nodes. He receives combination chemotherapy along with rituximab.

About 24 hours later, he reports feeling unwell and his investigations are shown below:

Serum sodium: 137 mmol/L (135-146)

Serum potassium: 5.6 mmol/L (3.5-5.0)

Calcium: 1.9 mmol/L (2.2-2.6)

Phosphate: 1.42 mmol/L (0.8-1.4)

Urea: 9.1 mmol/L (10-20)

Uric acid: 1.2 mmol/L –

Creatinine: 156 μmol/L (79-118)

Lactic acid dehydrogenase: 1845 IU/L (105 – 333)

What is the diagnosis?

MRCP2-2482

A 55-year-old woman is about to start chemotherapy for breast cancer. What steps should be taken to identify high-risk patients before initiating chemotherapy to prevent the development of hyperuricaemia, hyperkalaemia, hyperphosphataemia, hypocalcaemia, and acute kidney disease?

MRCP2-2483

A 32-year-old man presents to the Emergency Department with sudden onset pleuritic chest pain. He has recently returned from a business trip to China. He had a previous pulmonary embolism five years ago. He works as a software engineer and is married with no children.
On examination, he is short of breath and in distress. He is tachycardic with a blood pressure of 120/80 mmHg and a loud pulmonary component of the second heart sound. There is no pleural rub. His respiratory rate is 28 breaths per minute. Chest X-ray is clear.
Investigations:
s
p(O2) 8.2 kPa 11.3 – 12.6 kPa
p(CO2) 4.0 kPa 4.7 – 6.0 kPa
What is the most likely underlying diagnosis based on this patient’s presentation?