Archives: MRCP Part 2

MRCP2-2436

A 32-year-old woman is brought to the emergency department by her husband due to lethargy for the past 2 days and increasing confusion this morning. She has no significant medical history and is currently 20 weeks pregnant.

Upon examination, the patient has a fever of 38.5ºC, a heart rate of 125 bpm, and a blood pressure of 115/95 mmHg. Her chest is clear, and her heart sounds are normal. Her abdomen is soft and non-tender, with a palpable uterus consistent with 20 weeks gestation.

The following are the patient’s laboratory results:
– Hb: 92 g/L (normal range for females: 115-160)
– Platelets: 43 * 109/L (normal range: 150-400)
– WBC: 6.3 * 109/L (normal range: 4.0-11.0)
– Na+: 138 mmol/L (normal range: 135-145)
– K+: 3.8 mmol/L (normal range: 3.5-5.0)
– Urea: 11.2 mmol/L (normal range: 2.0-7.0)
– Creatinine: 185 µmol/L (normal range: 55-120)
– Bilirubin: 32 µmol/L (normal range: 3-17)
– ALP: 35 u/L (normal range: 30-100)
– ALT: 85 u/L (normal range: 3-40)
– Albumin: 37 g/L (normal range: 35-50)
– CRP: <1 mg/L (normal range: <5) Urinalysis is negative, and a pregnancy test is positive. What is the immediate next step in treating this patient?

MRCP2-2437

A 42-year-old female presents to haematology outpatients with complaints of fatigue, shortness of breath, and abnormal blood results as reported by her general practitioner. She has no medical history and is not taking any medications. The patient denies smoking or drinking alcohol and works in a bakery. On clinical examination, no abnormalities are noted. Blood tests reveal a hemoglobin level of 101 g/L, platelet count of 111 * 109/L, and a white blood cell count of 14.2 * 109/L. A blood film is ordered and shows the presence of Auer rods. Based on these findings, what is the most likely diagnosis?

MRCP2-2438

A 76-year-old man with chronic lymphocytic leukaemia (CLL) presents with spontaneous bruising. He denies any recent trauma and is currently taking aspirin, simvastatin, and ramipril for a previous heart attack.

During the examination, the patient appears to be in good health. His conjunctiva is pale, but his chest is clear, and he is well-perfused. Several purpura are visible on his arms, back, and chest. Palpable lymph nodes are present in the left inguinal area, but there is no hepatosplenomegaly.

Hb 104 g/l Na+ 135 mmol/l
Platelets 54 * 109/l K+ 4.0 mmol/l
WBC 10.3 * 109/l Urea 3.4 mmol/l
Neuts 6.7 * 109/l Creatinine 87 µmol/l
Lymphs 3.4 * 109/l CRP 14 mg/l
Eosin 0.1 * 109/l

What is the best course of action for managing this patient?

MRCP2-2439

A 67-year-old woman presents to the emergency department with a painful leg. She had noticed that her calf started to become tender when she was getting dressed in the morning and found it to be swollen. She was concerned and called her GP surgery who gave her an emergency appointment. She was seen by her GP earlier in the day who suspected a deep vein thrombosis and advised her to attend her local emergency department.

She has a past medical history of breast cancer which was operated on three months ago with a wide local excision, and she has been told that the operation was successful in removing the cancer. Her observations are stable. On examination, she has a swollen left calf which is mildly tender without erythema. A D-dimer sent by the emergency department team was positive but all other blood tests are normal. She undergoes a doppler ultrasound scan which shows no thrombus. How should she be further managed?

MRCP2-2440

For which condition is plasmapheresis the primary treatment option?

MRCP2-2441

A 41 year old man is brought to the Emergency Department by his wife. She has become worried about him in the past six months as he has become increasingly confused, aggressive and depressed. He has also lost 4kg in weight in this time and has developed severe, intermittent abdominal pain and diarrhoea, and complains of constant headaches.

Examination reveals a normal cardiorespiratory examination but the abdomen is diffusely tender and there is tender fullness in the right upper quadrant. Neurological examination reveals minor hypotonia throughout and there are bilateral radial nerve palsies as well as a left common peroneal nerve palsy. Sensation appears intact. He is alert but confused with an abbreviated mental test score of 7/10.

Blood tests reveal:

Sodium 136 mmol/L ALP 135U/L Haemoglobin 79g/L
Potassium 5.1mmol/L AST 265U/L MCV 101 fL
Urea 7.1mmol/L ALT 298U/L White cells 9.4×10^9/L
Creatinine 102µmol/L GGT 197U/L Neutrophils 5.6×10^9/L
CRP 10 mg/L Bilirubin 12µmol/L Lymphocytes 3.1×10^9/L
Calcium (corr) 2.34mmol/L Eosinophils 0.1×10^9/L
Phosphate 0.56mmol/L Basophils 0.6×10^9/L
Magnesium 0.76mmol/L
Glucose 3.8 mmol/L

The blood film shows anaemia with a dimorphic picture, significant reticulocytosis and high basophil numbers with cytoplasmic stippling.

The patient’s wife tells you all the symptoms coincided with the patient starting a new job as a loading crane driver at a scrap-yard.

What is the most likely diagnosis?

MRCP2-2442

A 63-year-old woman presents for follow-up. She completed a 6-month course of warfarin a year ago after being diagnosed with an unprovoked, proximal deep vein thrombosis. Over the past few weeks, she has been experiencing a sensation of heaviness and aching in the same leg, accompanied by itching and some swelling that subsides each night. Her medical history includes osteoarthritis and type 2 diabetes mellitus. On examination, there are prominent varicose veins on the affected leg, and the skin above the medial malleolus is discolored. The calves’ circumference is equal, and her vital signs are within normal limits. What is the most probable diagnosis?

MRCP2-2443

A 33-year-old man presents to the emergency department complaining of abdominal pain. He has a history of multiple previous visits with similar symptoms that usually last for 3-7 days before resolving. During a previous visit, he underwent an exploratory laparoscopy, which did not reveal any cause for his symptoms. He has a medical history of depression and is currently taking citalopram. He does not smoke or drink alcohol and works as a ceramicist. He has been experiencing a lot of work-related stress lately.

Upon examination, his vital signs are heart rate 111 beats per minute, blood pressure 153/74 mmHg, respiratory rate 18/minute, oxygen saturation 96% on room air, and temperature 37ºC. His abdomen is soft and non-tender with normal bowel sounds, and there are no abnormalities of the external genitalia. However, a bilateral foot drop is noted during neurological examination.

Blood tests reveal an Hb of 136 g/L, platelets of 189 * 109/L, WBC of 5.6 * 109/L, Na+ of 129 mmol/L, K+ of 4.2 mmol/L, urea of 8.2 mmol/L, CRP of 23 mg/L, and lactate of 1.2 mmol/L. A urine sample is requested and is noted to turn dark red when left standing. Porphobilinogen is increased in the urine. Plain radiography of the abdomen and chest are normal.

What is the most appropriate treatment for this likely diagnosis?

MRCP2-2444

The hospital is low on its supply of CMV seronegative blood products and needs to prioritize patients. Which patient should be given the highest priority, considering all options?

The hospital is running low on its stock of cytomegalovirus (CMV) seronegative blood products. All the blood products are routinely leuko-depleted to reduce the risk of transferring CMV. You are asked to prioritize patients for CMV seronegative blood.

From the following options, which patient is the highest priority?

MRCP2-2445

A 61-year-old woman comes to the haematology clinic for evaluation. Despite undergoing treatment with cyclophosphamide, rituximab, and fludarabine (FCR), she has been experiencing a gradual increase in her lymphocyte count, along with symptomatic anaemia. Upon examination, there are indications of anaemia, her body mass index is 22 kg/m², and there is noticeable splenomegaly.

What is the most suitable course of action?