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?

MRCP2-2340

A 63-year-old man has been regularly visiting the haematology clinic every six months. During his latest appointment, he complained of a headache, blurred vision, aching bones, and extreme lethargy. His wife reported that he has been very vague at times over the past four weeks and drowsy when he was awake.

Upon examination, he appeared pale with a blood pressure of 125/65 mmHg. He was afebrile, and his respiratory rate was 12 breaths per minute. Cardiovascular, chest, and abdominal examination were unremarkable.

Further investigations revealed a haemoglobin level of 82 g/L (130-180), MCV of 88 fL (80-96), white cell count of 9.0 ×109/L (4-11), and a monoclonal band (IgA kappa) with immune paresis. The IgA kappa level was 76 g/L.

Which of the following treatment options would be best for this patient?

MRCP2-2341

A 65 year-old woman presents with worsening back pain over the past month, despite never experiencing it before. She has been feeling lethargic and her husband has noticed occasional confusion. She also reports long-standing exertional breathlessness and constipation, but no bowel or bladder issues.

Her medical history includes chronic obstructive pulmonary disease, which is being managed by her GP, and quitting smoking two years ago. Her last well woman check up was normal, except for slightly elevated cholesterol that she is managing with diet.

During examination, she walks normally and has mild tenderness over the L3/L4 vertebra with no neurological deficits in her lower limbs. Cardiorespiratory examination reveals an ejection systolic murmur and a normal second heart sound.

Lab results show low hemoglobin, normal bilirubin, elevated platelets, high potassium, elevated ALP, normal ALT, high creatinine, and high corrected calcium. Her ESR is also elevated.

What is the most likely diagnosis?

MRCP2-2342

A 29-year-old teacher was referred to the hospital by her general practitioner. She had presented seven days ago with a three day history of malaise, headache, and myalgia and subsequently developed a dry cough and fever. Her GP had prescribed amoxicillin/clavulanic acid, but the symptoms failed to resolve. On the day of referral, the patient continued to complain of cough and had become mildly dyspnoeic; she also complained of a global headache, myalgia and arthralgia.

During the examination, she appeared unwell and was febrile (39°C). A maculopapular rash was evident over her upper body. Heart sounds were normal; BP 120/70 mmHg. On auscultation of her chest, fine crackles were audible in the left mid-zone. Mild neck stiffness was noted.

The following investigations were conducted:
– Hb 84 g/L (130-180)
– WBC 8 ×109/L (4-11)
– Platelets 210 ×109/L (150-400)
– Reticulocytes 8% (0.5-2.4)
– Na 129 mmol/L (137-144)
– K 4.2 mmol/L (3.5-4.9)
– Urea 5.0 mmol/L (2.5-7.5)
– Creatinine 110 µmol/L (60-110)
– Bilirubin 19 µmol/L (1-22)
– Alk phos 130 U/L (45-105)
– AST 54 U/L (1-31)
– GGT 48 U/L (<50) The chest x-ray showed patchy consolidation in both mid-zones. What investigation should be performed to confirm the cause of her abnormal blood count?

MRCP2-2343

A 65-year-old man with a history of myelodysplasia visits a haematology clinic complaining of rapid weight loss, increased nosebleeds, and more pronounced fatigue than before. He has the single lineage dysplasia subtype and typically requires monthly transfusions. He presents two weeks after his last red blood cell top-up.

Upon examination, his blood results reveal the following:

– Hb 66 g/L (normal range for males: 135-180; females: 115-160)
– Platelets 9 * 109/L (normal range: 150-400)
– WBC 1.1 * 109/L (normal range: 4.0-11.0)

As a result, he is admitted for blood and platelet transfusions, and a blood film is ordered. What is the expected outcome of the blood film analysis?

MRCP2-2344

A 70-year-old man presents to the clinic with a four-month history of breathlessness, abdominal swelling, and discomfort. Upon examination, he appears pale and unwell, with a palpable liver and spleen. Laboratory investigations reveal abnormal blood counts and a blood film showing anisocytosis, poikilocytosis, and occasional erythrocyte tear drop cells. What is the initial diagnostic test of choice?

MRCP2-2345

An 80-year-old man presents to haematology with complaints of fatigue and weight loss. Despite undergoing upper and lower GI endoscopy, which showed no abnormalities, he has been referred for further investigation of anaemia. The following blood film was obtained:

What is the probable diagnosis?

MRCP2-2346

A 65-year-old man complains of weakness in his left leg that he first noticed a couple of weeks ago. Upon examination, you observe weakness in left ankle plantar flexion. The nerve conduction studies of the tibial nerve reveal a conduction velocity of 25 metres per second (normal >50) and an amplitude of 21mV (normal >17). What is the probable cause of this weakness?