Archives: MRCP Part 2

MRCP2-2459

A 70-year-old man presents to the emergency department after a fall. Upon examination, his right leg is externally rotated and shortened, and he is unable to bear weight. An X-ray of his hip reveals a pathological fracture of the femoral neck. The patient has no history of cancer. After undergoing dynamic hip screw insertion, he recovers well. Blood tests are ordered for FBC, U&E, LDH, calcium, albumin, uric acid, serum electrophoresis, immunoglobulins, and ESR. A chest X-ray has been performed and is normal.

What further tests should be requested to fully investigate the pathological nature of the fracture?

MRCP2-2460

A 27-year-old man with a history of ankylosing spondylitis and a clavicular fracture presents to haematology clinic one week before starting chemotherapy for acute myeloid leukaemia (AML). He is experiencing chronic lower back pain, night sweats, and fatigue, and is eager to begin treatment. His current medications include paracetamol and ibuprofen. Blood tests reveal a Hb level of 113 g/l, platelet count of 156 * 109/l, and WBC count of 57 * 109/l, with normal electrolyte and renal function.

Which of the following measures is the least effective in preventing tumour lysis syndrome?

MRCP2-2461

A 30-year-old woman has been diagnosed with hereditary angioedema and is scheduled for an elective meniscal repair on her left knee. She has not experienced any recent changes in her health or medication. What is the preferred prophylactic drug for hereditary angioedema before her procedure?

MRCP2-2462

An 80-year-old woman presented to the haematology day unit for evaluation. She reported experiencing lethargy, headaches, and visual disturbances for the past two weeks. Her daughter, who accompanied her, noticed that her mother had been slightly confused in the past 24 hours. Upon examination, the patient had a blood pressure of 100/60 mmHg and a heart rate of 88 beats per minute. Mild pitting oedema of her ankles and scattered bilateral basal fine crepitations were observed. The rest of the examination was unremarkable, and her mini mental score was 30.

Further investigations revealed a haemoglobin level of 72 g/L, MCV of 88 fL, white cell count of 9.0 ×109/L, and an IgA kappa monoclonal band with immune paresis. The patient was given three units of red cells, each unit running at an infusion rate of two hours. However, following the first unit, the patient became acutely short of breath, confused, and complained of a severe headache. Her blood pressure was recorded as 70/40 mmHg with a regular heart rate of 120 beats per minute. She was afebrile with oxygen saturation of 88% on air. Given this information, what is the most likely cause of her acute deterioration?

MRCP2-2463

A 30-year-old woman with mild type 1 von Willebrand disease has been referred to you for elective dental extractions. What recommendations would you make regarding her optimal haemostatic options?

MRCP2-2464

A 28-year-old male patient is scheduled for lumbar spine surgery and has disclosed that he was recently diagnosed with type 1 von Willebrand disease after experiencing bleeding following a minor surgical procedure. You consult with the haematologists and arrange for crossmatched blood and platelets to be available on the day of the surgery. What haematological product should be given before the surgery?

MRCP2-2465

A 49-year-old man with no significant medical history presents with a one-week history of fatigue. Upon investigation, his blood count reveals a white blood cell count of 4.6 ×109/L (4-11), hemoglobin level of 75 g/L (115-165), platelet count of 251 ×109/L (150-400), and a reticulocyte count of 451 ×109/L (25-85). His LDH level is elevated at 650 U/L (10-250), and his peripheral smear shows spherocytes. The direct antiglobulin test (DAT or Coombs’ test) is positive for warm antibodies.

Which of the following treatment options would you recommend for this patient?

MRCP2-2466

A 25-year-old woman has been diagnosed with severe type 1 von Willebrand disease and needs to undergo an emergency appendectomy. The coagulation laboratory has been informed that monitoring will be necessary with either vWF:RCo or vWF:Ag. Which coagulation factor is the most suitable for managing this patient with von Willebrand disease?

MRCP2-2467

A 56-year-old man presents to the clinic with concerns about his ability to play the guitar. He reports experiencing 2 hours of morning stiffness and pain in his hips, knees, and elbows. Upon examination, nodules are found over his elbows and he experiences pain in the PIP joints of his fingers. His lab results show a low hemoglobin level of 119 g/l (normal range: 135-175 g/l) and an elevated ESR of 45 mm/hour (normal range: <10mm/hour). What is the most appropriate initial therapy for this man to ensure his long-term ability to play the guitar?

MRCP2-2468

A 42-year-old woman has been diagnosed with stage II non-bulky follicular lymphoma (low grade). During a routine examination, her GP noticed a few small neck nodes, but she is otherwise asymptomatic. Her full blood count, renal function, and LDH are all normal. What would be the most appropriate next step in her management plan?