Archives: MRCP Part 2

MRCP2-2361

A 67-year-old man presents with back pain. He was recently diagnosed with peripheral neuropathy but the cause is unknown. He has no other medical history and takes no regular medications. During examination, tenderness of his lumbar spine is noted along with hepatosplenomegaly and hyperpigmentation of his skin. Blood tests reveal low hemoglobin, elevated creatinine, and a monoclonal band with an IgG light chain spike. A whole body MRI scan shows an osteoblastic lesion in the L4 vertebrae. What is the most likely diagnosis?

MRCP2-2362

A 72-year-old retired steel industry worker has been diagnosed with renal cell carcinoma. His blood test results show significant abnormalities:
– Haemoglobin (Hb) 203 g/L (130-180)
– Haematocrit (PCV) 0.60% (0.40-0.52)
– Mean cell volume (MCV) 90 fL (84-96)
– White cell count (WBC) 10 ×109/L (4.0-11.0)
– Platelets 400 ×109/L (150-450)

Which of the following symptoms can be attributed to the above blood test results?

MRCP2-2363

A 67-year-old man presents with sudden-onset left upper limb and lower limb weakness. He has a history of headaches but is otherwise healthy, never smoked, and drinks two pints of beer a day. On examination, he has a left-sided motor and sensory deficit, an ejection systolic murmur at the right second intercostal space, and a mass in the left upper quadrant of his abdomen that moves downwards on inspiration. His blood pressure is 157/89 mmHg, heart rate 70 bpm and regular, temperature 36.9 °C, and oxygen saturation 97%. Laboratory investigations reveal elevated haemoglobin, white cell count, platelets, and leukocyte alkaline phosphatase score, as well as high levels of sodium, potassium, urea, and creatinine. What is the most likely diagnosis?

MRCP2-2333

A 36-year-old patient with a history of sickle cell disease presents to the emergency department with sudden onset of left arm and facial weakness. The symptoms started earlier in the day. The patient is usually very cautious with his sickle disease and ensures he stays hydrated and avoids cold temperatures. However, his wife reports that he has been experiencing nausea, vomiting, and diarrhea for the past few days after eating a takeaway meal three days ago. Upon examination, the patient’s vital signs are normal. He has slurred speech and a noticeable left facial droop with forehead sparing. He has no other neurological deficits except for a left arm power of 0/5.

The patient’s blood tests reveal:

– Hemoglobin: 100 g/L
– Platelets: 330 * 10^9/L
– White blood cells: 8.9 * 10^9/L
– INR: 1.0
– Sodium: 138 mmol/L
– Potassium: 3.5 mmol/L
– Urea: 9.9 mmol/L
– Creatinine: 135 µmol/L
– CRP: 19 mg/L (<10)
– Bilirubin: 12 µmol/L
– ALP: 89 U/L
– ALT: 39 U/L
– Albumin: 39 g/L

The stroke team evaluates the patient and orders an urgent CT head, which comes back normal. What is the appropriate treatment for this patient?

MRCP2-2334

A 20-year-old Zimbabwean male has been experiencing massive painless cervical lymphadenopathy for the past two weeks. What diagnostic investigation should be conducted to determine the cause?

MRCP2-2335

A 27-year-old man has been rushed to the emergency room after a car accident. He has suffered severe abdominal trauma, including lacerations to his spleen and liver. During his treatment, he has been given 7 liters of fluid, a combination of colloid and red cell concentrate. However, he continues to experience persistent bleeding from his surgical wounds. His blood tests reveal a hemoglobin level of 85 g/L (normal range: 130-180), a hematocrit of 33%, a fibrinogen level of 0.8 g/L (normal range: 1.8-5.4), and a platelet count of 80 ×109/L (normal range: 150-400). Additionally, his PT and APTT levels are twice the upper limit of the control. What would be the most appropriate products to use for replacement in this case?

MRCP2-2336

A 67-year-old male presents with a 2 year history of fatigue. Over the past year he has had progressive early satiety, vomiting and weight loss. On examination you note 10cm splenomegaly.

Investigation results are as follows:

Hb 84g/l Na+ 138 mmol/l Bilirubin 22 µmol/l
Platelets 65 * 109/l K+ 3.7 mmol/l ALP 88 u/l
WBC 2.2 * 109/l Urea 4.5 mmol/l ALT 22 u/l
Neuts 0.8 * 109/l Creatinine 68 µmol/l γGT 96 u/l
Lymphs 0.4 * 109/l Albumin 28 g/l

Blood film: Tear-drop poikilocytes

What is the most likely diagnosis?

MRCP2-2337

A 55-year-old man presents with abdominal pain. He was seen eight weeks ago by surgeons who diagnosed gastritis and offered omeprazole. He initially improved but the pain recurred and he has no benefit with omeprazole or gaviscon. He feels full quickly but has no dysphagia or regurgitation. He denies any heartburn. He reports general low energy and is sleeping more hours in the day and can fall asleep at any time.

On examination, a mass is palpable in the epigastrium. It has a palpable indent and you cannot get above it. There are bowel sounds and no other masses are felt. There are some isolated left axillary lymph nodes palpable. His temperature is 37.8ºC and heart rate is 78 beats per minute.

Based on the given information, what is the most probable underlying diagnosis?

MRCP2-2338

A 35-year-old man presented to outpatients with abnormal liver function tests. He had been experiencing lethargy and general malaise and had visited his GP. The patient worked on his family’s dairy farm and regularly consumed 30 units of alcohol per week. He had a history of hypothyroidism and was taking thyroxine. He denied drug abuse, had never had a blood transfusion, and had not traveled abroad. On examination, he appeared well and did not exhibit any signs of chronic liver disease. His test results showed a haemoglobin level of 142 g/L (130-180), white cells at 9.0 ×109/L (4-11), platelets at 300 ×109/L (150-400), MCV at 102 fL (80-96), albumin at 40 g/L (37-49), bilirubin at 35 μmol/L (1-22), alanine transferase at 210 U/L (5-35), alkaline phosphatase at 140 U/L (45-105), gamma glutamyltransferase at 120 U/L (<50), smooth muscle antibody detected at 1:200, anti-mitochondrial antibody not detected, serum IgG at 23 g/L (6-13), and serum IgA at 1 g/L (0.8-3). What is the underlying cause of his liver dysfunction?

MRCP2-2339

A 65 year old man presents to his GP for routine screening. He has a medical history of hypertension and has been taking amlodipine for several years. He reports no specific symptoms and is still working full time. His blood pressure is 132/78 mmHg and urinalysis is normal. Blood tests were taken for routine monitoring.

Hb 13.8 g/dl
Platelets 362 * 109/l
WBC 6.3 * 109/l

Na+ 142 mmol/l
K+ 4.2 mmol/l
Urea 4.6 mmol/l
Creatinine 84 µmol/l

Adjusted calcium 2.41mmol/l
Lactate Dehydrogenase 300 IU/l
Albumin 36 g/l
Globulin 52 g/l

During analysis, an abnormal protein band is detected and the GP refers the patient to a Haematologist for further review. Additional investigations reveal a monoclonal paraprotein level of 18g/l, 6% plasma cells on bone marrow examination, and no abnormalities on skeletal survey. What is the diagnosis?