Archives: MRCP Part 2

MRCP2-4555

A 30-year-old woman delivers a baby who is diagnosed with complete heart block and needs a pacemaker. What antibody is expected to be found in the mother’s serum?

MRCP2-4556

A 59-year-old man presents with Raynaud’s phenomenon and progressive difficulty in climbing stairs. He has also noticed cracking and peeling of the skin on the fingertips and on the lateral aspect of his hands.

On examination, the power is 4/5 proximally, with intact reflexes and downward going plantars.

Recent blood tests are as follows:

– Hb 131 g/L (130-180)
– WBC 9.9 ×109/L (4-11)
– Neutrophils 88% (40-75)
– Platelet 196 ×109/L (150-400)
– ESR 66 mm/hr (0-20)
– CK 1200 IU/mL (24-195)
– CRP 131 mg/L (<10) Urea, electrolytes and creatinine are normal. Liver function tests normal. Anti-nuclear antibody negative. Anti-dsDNA antibody negative. Anti-Ro/La antibody negative. Anti-Jo1 antibody positive. What is the diagnosis?

MRCP2-4557

A 45-year-old non-smoking woman presents with weakness in her left arm (power 3/5) and left-sided facial drooping. These symptoms resolve within an hour of being examined by the admitting doctor. She has normal heart sounds, peripheral pulses, and is in sinus rhythm. As part of her workup, she undergoes blood tests and other investigations. The results show thrombocytopenia, no schistocytes, and the following values: Hb 130 g/L (115-165), WBC 9.5 ×109/L (4-11), Neutrophils 72% (40-75), Platelet 75 ×109/L (150-400), ESR 8 mm/hr (0-15), INR 1.0 (<1.4), aPTT 50 seconds (30-40 seconds), and aPTT did not normalize after addition of plasma. Urea, electrolytes, and creatinine are normal, and CT head and echocardiogram are also normal. What is the most likely cause of her symptoms?

MRCP2-4558

A 40-year-old man with a history of diabetes presented to the clinic with bilateral knee pain. On examination, he appeared suntanned with sparse body hair and the knees were swollen and tender, with limited range of movement. He works as an insurance salesman, is a non-smoker but drinks on most weekends, and is on insulin for the diabetes and also takes sildenafil occasionally for erectile dysfunction. The investigations revealed abnormal results for sodium, potassium, creatinine, albumin, bilirubin, ALT, AST, GGT, glucose, LH, FSH, and testosterone. Additionally, an X-ray of the knees showed calcification present. What is the most likely cause of the joint abnormality?

MRCP2-4559

An older woman undergoes routine blood tests prior to a hernia repair. Her liver function tests are repeated twice, with calcium, ALT, and bilirubin within normal limits, but her alkaline phosphatase level is elevated at 380. Upon further inquiry, she reports drinking a glass of wine and smoking 6 cigarettes per day, as well as experiencing hip and lower back pain. She has also recently been evaluated for hearing impairment. What is the most appropriate test to confirm the diagnosis?

MRCP2-4535

A 85-year-old female presents to the emergency department with a four-day history of increasing shortness of breath and worsening of a chronic productive cough. She does not speak English, but her medical records indicate that she recently moved from rural India to live with her family two years ago. There is no known underlying lung condition. Upon examination, bilateral expiratory wheeze and hyperexpanded lungs are observed, with no clear inspiratory crackles. Heart sounds appear normal, and mild bilateral pitting edema is present. Her saturation measures 88% on air via pulse oximeter, and her respiratory rate is 24 to 28 per minute. A chest radiograph shows hyperexpanded lungs with mild bibasal fibrotic changes but no focal signs of consolidation. She has no history of smoking or alcohol use. Her blood tests reveal:

– Hb 15.0 g/dl
– Platelets 211 * 109/l
– WBC 11.4 * 109/l
– Neutrophils 9.5 * 109/l
– Urea 8.4 mmol/l
– Creatinine 112 µmol/l
– CRP 37 mg/l

What is the most likely diagnosis?

MRCP2-4536

A 31-year-old man presents with a history of recurrent ulcers over several months. He reports experiencing oral ulcers regularly, with multiple occurring at a time, which typically resolve within a week. Additionally, he has been experiencing painless genital ulcers. He has recently attended the eye casualty department twice, where he was diagnosed with uveitis. On examination today, he has several oral ulcers and genital ulcers. What findings would support the probable diagnosis?

MRCP2-4537

A 55-year-old man of Afro-Caribbean descent presents to the clinic with complaints of fever, joint pain, and lethargy. He has also noticed a rash on his arms and neck that comes and goes over the past six months. He has a medical history of congestive heart failure and chronic kidney disease due to hypertension. His current medications include bisoprolol, aspirin, and hydralazine/isosorbide dinitrate. On examination, there is no joint swelling, but he has patches of scaling on his neck and forearms. Laboratory tests reveal positive rheumatoid factor, anti-nuclear antibody, anti-single stranded DNA, and anti-histone antibodies, but negative anti-extractable nuclear antigen. What is the most likely diagnosis?

MRCP2-4538

A 75-year-old male presents to the Emergency Department with a two-day history of right temporal, throbbing headache, constant in nature and 8/10 severity. He reports this being the first ever episode of this headache and is different to his previous migraines, which have been typically in the left occipital region, lasting minutes, and fairly stereotyped over the past 50 years. Apart from migraines, he has no other medical history.

On examination, his right scalp is tender and a prominent right temporal artery is noted. He is apyrexic with no skin rashes. His blood tests are as follows:

Hb 140 g/l
Platelets 550 * 109/l
WBC 11.0 * 109/l
ESR 80 mm/hr

Na+ 145 mmol/l
K+ 4.5 mmol/l
Urea 9.8 mmol/l
Creatinine 110 µmol/l
CRP 25 mg/l

You empirically start him on 60mg prednisolone. He undergoes temporal artery biopsy within 24 hours of his admission demonstrating no signs of temporal arteritis.

What is the most appropriate next step?

MRCP2-4541

A 65-year-old woman presents to the Emergency department with a one-week history of increasing breathlessness and coughing up small amounts of blood. She also reports frequent nosebleeds and headaches over the past two months, as well as feeling generally lethargic and losing weight. On examination, there are no signs of cyanosis, finger clubbing, pallor, or skin rash. The pulse is 100 beats/min and BP is 135/95 mmHg. Respiratory rate is 28 breaths/min, chest expansion is moderate, and inspiratory crackles are heard at the left lung base.

The following investigations were conducted: Hb 100 g/L (115-165), WCC 19.9 ×109/L (4-11), Platelets 540 ×109/L (150-400), Plasma sodium 139 mmol/L (137-144), Plasma potassium 5.3 mmol/L (3.5-4.9), Plasma urea 30.6 mmol/L (2.5-7.5), Plasma creatinine 760 µmol/L (60-110), Plasma glucose 5.8 mmol/L (3.0-6.0), Plasma bicarbonate 8 mmol/L (20-28), Plasma calcium 2.23 mmol/L (2.2-2.6), Plasma phosphate 1.7 mmol/L (0.8-1.4), Plasma albumin 33 g/L (37-49), Bilirubin 8 µmol/L (1-22), Plasma alkaline phosphatase 380 U/L (45-105), Plasma aspartate transaminase 65 U/L (5-35). Arterial blood gases on air reveal: pH 7.2 (7.36-7.44), pCO2 4.0 kPa (4.7-6.0), pO2 9.5 kPa (11.3-12.6). ECG shows sinus tachycardia and chest x-ray reveals a shadow in the left lower lobe. Urinalysis shows blood +++ and protein ++.

Which of the following would you expect to be positive in this patient?