Archives: MRCP Part 2

MRCP2-2387

A 50-year-old woman visits her doctor complaining of a painful rash on her breasts. The rash appeared within the last day and has become more defined and darker in color. She recently started taking warfarin for a deep vein thrombosis and has a medical history of hypothyroidism, type two diabetes, and obesity. She has been on warfarin before but does not recall experiencing this rash. Her blood tests show a prothrombin time of 21.4 seconds and an INR of 2.1. What is the most likely diagnosis?

MRCP2-2388

A 35-year-old man with chronic immune thrombocytopenia is scheduled to undergo an elective splenectomy after failing to respond to medical therapy. As per guidelines, which vaccinations does he require?

MRCP2-2389

A 62-year-old male comes to the clinic with a platelet count of 768 ×109/L (150 – 400). He has mild splenomegaly upon examination, but no other significant findings in his history or physical exam. What diagnostic test would be most helpful in determining the cause of his elevated platelet count?

MRCP2-2390

A 42-year-old woman presents to her primary care physician (PCP) with complaints of unexplained weight loss over the past six months and excessive sweating at night. She also reports experiencing persistent itching all over her body. She has no significant medical history and is a non-smoker. She has not traveled recently.
Upon examination, the patient is afebrile, but there is symmetrical lymphadenopathy in the cervical and supraclavicular regions. No hepatomegaly or splenomegaly is noted.
The following laboratory results are obtained:
Erythrocyte sedimentation rate (ESR) 175 mm/hour 1–20 mm/hour
Hemoglobin (Hb) 140 g/l 135–175 g/l
White blood cell count (WBC) 5.2 × 109/l 4.0–11.0 × 109/l
Platelet count (PLT) 300 × 109/l 150–400 × 109/l
Sodium (Na+) 142 mmol/l 135–145 mmol/l
Potassium (K+) 4.0 mmol/l 3.5–5.0 mmol/l
Urea 5.0 mmol/l 2.5–6.5 mmol/l
Creatinine (Cr) 80 µmol/l 50–120 µmol/l
A CT scan of the chest, abdomen, and pelvis reveals involvement of lymph nodes in the neck, chest, and abdomen. A lymph node biopsy confirms the diagnosis of Hodgkin’s lymphoma.
What would be the clinical stage of this patient’s disease according to the Ann Arbor classification?

MRCP2-2391

A 65-year-old woman presents to her new primary care physician with complaints of fatigue and weakness. She has a history of high blood pressure managed with lisinopril and amlodipine and has been experiencing back pain for the past 6 months. On examination, her blood pressure is 130/70 mmHg, pulse is 80 bpm and regular, and there is mild bilateral ankle edema.
Lab results show:
– Hemoglobin (Hb): 105 g/L (normal range: 120-160 g/L)
– White blood cell count (WBC): 12.2 x 10^9/L (normal range: 4.0-11.0 x 10^9/L)
– Platelets (PLT): 180 x 10^9/L (normal range: 150-400 x 10^9/L)
– Sodium (Na+): 140 mmol/L (normal range: 135-145 mmol/L)
– Potassium (K+): 4.2 mmol/L (normal range: 3.5-5.0 mmol/L)
– Creatinine (Cr): 100 µmol/L (normal range: 50-120 µmol/L)
– Albumin: 30 g/L (normal range: 35-55 g/L)
– Total protein: 62 g/L (normal range: 60-83 g/L)

Which of the following findings would be most suggestive of symptomatic myeloma?

MRCP2-2364

A 42-year-old woman with type 1 diabetes mellitus has not attended the diabetic clinic for three years.

Examination shows no abnormalities.

Investigations show:

Haemoglobin 90 g/L (115-165)

MCV 94 fL (80-96)

Haematocrit 28% –

HbA1c 87 mmol/mol (20-42)

10.1% (3.8-6.4)

A blood smear shows normochromic, normocytic anaemia.

What is the most likely cause of the anaemia?

MRCP2-2365

A patient admitted to the haematology ward experiences a temperature increase of 1ºC just five minutes after commencing a platelet transfusion. Despite feeling hot, the patient is in good health and their blood pressure, pulse, and oxygen saturations remain unchanged from pre-transfusion observations. After an hour, the patient is still febrile but otherwise stable. What could be the probable cause of the fever in this patient?

Additionally, it is important to note that the patient’s age was not specified in the original question.

MRCP2-2366

A 38-year-old male ex-IVDU presents to A&E with worsening cramping pains in his legs and bloody diarrhoea that has been ongoing for several weeks. He also reports back pain that started six weeks ago and has not improved. The patient has a history of intermittent claudication and a recent ABPI indicates severe disease. A full body CT angiogram reveals emboli in the leg and mesentery, as well as a larger mass in the ascending aorta. On examination, an ejection systolic murmur is heard loudest at the right heart border 2nd heart border. The patient’s observations are stable and he is apyrexial. What is the most likely underlying diagnosis?

MRCP2-2367

A 35-year-old woman presents to the Emergency Department with severe fatigue, shortness of breath, and difficulty walking more than a few yards. She reports feeling generally unwell with fevers, weight loss, and a dry cough over the past few months. She has a history of IV drug abuse and recently moved to the UK from southern Italy.
On examination, her blood pressure is 110/75 mmHg, with a pulse of 92/min and regular rhythm. She appears pale and has generalised lymphadenopathy. Her BMI is 19.
Investigations reveal:
– Haemoglobin (Hb): 80 g/l (reticulocyte count not elevated) (normal range: 135 – 175 g/l)
– White cell count (WCC): 3.8 × 109/l (normal range: 4.0 – 11.0 × 109/l)
– Platelets (PLT): 210 × 109/l (normal range: 150 – 400 × 109/l)
– Sodium (Na+): 138 mmol/l (normal range: 135 – 145 mmol/l)
– Potassium (K+): 4.2 mmol/l (normal range: 3.5 – 5.0 mmol/l)
– Creatinine (Cr): 115 µmol/l (normal range: 50 – 120 µmol/l)
– Erythrocyte sedimentation rate (ESR): 70 mm/h (normal range: 1 – 20 mm/h)
Bone marrow aspirate shows pure red cell aplasia.
What is the most likely diagnosis for this patient?