MRCP2-2276
A 65-year-old woman who has previously experienced unprovoked VTE is scheduled to take a flight that will last for more than 8 hours.
What is the recommended approach for her thromboprophylaxis in this situation?
Archives: MRCP Part 2
MRCP2-2277
You are asked to evaluate a 22-year-old patient who has arrived at the Emergency department with bloody diarrhoea. The patient has been experiencing diarrhoea for the past two weeks, along with increasing nausea, malaise, and mild swelling in the lower limbs. She also had difficulty passing urine. The patient had consumed steak from a local butcher at a friend’s barbecue the day before the onset of diarrhoea.
During the examination, you notice that the patient is pale with petechiae over her legs and a puffy face. Her blood pressure is 160/95 mmHg, and she has a tachycardia and crackles on inspiration at both lung bases. You also observe an old appendicectomy scar in the right iliac fossa.
The following investigations were conducted:
– Haemoglobin: 85 g/L (115-165)
– White cell count: 13.2 ×109/L (4-11)
– Neutrophils: 9.5 ×109/L (1.5-7)
– Platelets: 35 ×109/L (150-400)
– PT: 12 s (11.5-15.5)
– APTT: 34 s (30-40)
– Fibrinogen: 4 g/L (1.8-5.4)
– Serum sodium: 139 mmol/L (137-144)
– Serum potassium: 6.1 mmol/L (3.5-4.9)
– Serum urea: 40 mmol/L (2.5-7.5)
– Serum creatinine: 411 µmol/L (60-110)
– Serum albumin: 27 g/L (37-49)
– Dipstick urine: Blood ++ Protein +
What is the most crucial investigation that needs to be conducted next to determine the diagnosis?
MRCP2-2278
A 43-year-old man has been receiving thrice weekly haemodialysis for the past 10 days through a subclavian line. However, over the last two days, he has been experiencing frequent clotting of the line and has noticed some red skin lesions. Four years ago, he had a deep vein thrombosis when he was nephrotic, which was treated with low molecular weight heparin and warfarin. He is currently taking erythropoietin (EPO) and alphacalcidol, and unfractionated heparin is being used for both the subclavian and dialysis lines. On examination, several necrotic skin lesions were found on his lower legs. Further investigations revealed thrombocytopenia and abnormal coagulation parameters. What should be the next step in his management?
MRCP2-2279
A 72-year-old man comes to you complaining of difficulty breathing during physical activity. He reports no chest pain, coughing, or wheezing. He has a medical history of Hodgkin’s lymphoma. Upon examination, his cardiopulmonary system appears normal.
The results of his blood test are as follows:
– Hemoglobin (Hb): 55 g/l
– Platelets: 346 * 109/l
– White blood cells (WBC): 8.4 * 109/l
You decide to administer two units of red blood cells. What specific request will you make?
MRCP2-2280
A 28-year-old man with Burkitt’s lymphoma is admitted for induction chemotherapy. However, within 48 hours of admission, his urine output drops to 20 mls/hr. Upon further investigation, his potassium levels are found to be 6.5 mmol/L (3.5-4.9), calcium levels at 1.5 mmol/L (2.2-2.6), phosphate levels at 4 mmol/L (0.8-1.4), and creatinine levels at 250 µmol/L (60-110). What is the most appropriate management for this complication?
MRCP2-2281
A 40-year-old man has been referred to the clinic by his GP due to a 12-month history of night sweats, weight loss, itching, and chronic cough. He reports no significant GI issues but has recently experienced shortness of breath when climbing stairs and has developed an urticarial rash. The following investigations were conducted: eosinophils were 3.0 × 109/l or greater on three occasions in the last year (normal value: 0.04–0.4 × 109/l), creatinine (Cr) was 128 μmol/l (normal value: 50–120 μmol/l), ANCA was negative, CXR showed interstitial infiltrates and small bilateral pleural effusions, echocardiogram (Echo) was suggestive of restrictive cardiomyopathy, and IgE was raised. What is the most likely diagnosis in this case?
MRCP2-2282
A 35-year-old woman presents with a fever of 38.0°C, 90 minutes after starting a red cell transfusion three days post allogeneic bone marrow transplant. Prior to the transfusion, her temperature was 37.6°C. On examination, she appears flushed, breathless, and complains of dizziness and a tight chest. Her heart rate is 110 beats per minute and regular, blood pressure is 90/60 mmHg, and auscultation of the chest reveals widespread wheeze. The staff nurse stops the transfusion and checks a full blood count, which shows abnormal results. The patient’s haemoglobin, white cell count, neutrophils, lymphocytes, monocytes, eosinophils, basophils, and platelet count are all outside of the normal range. What other action should be taken?
MRCP2-2283
A 37-year-old male presents to the emergency department with pain in his left leg, which he attributes to twisting his ankle while playing basketball with his friends approximately 1 week ago. He does not recall any insect bites but has become increasingly concerned as his leg has become more swollen and tender in the calf region.
He has no significant medical history but has been taking ibuprofen for the pain. His only other medication is a daily multivitamin. He consumes alcohol socially at the weekends and smokes approximately 5-10 cigarettes a day. On physical exam he is afebrile and his other vital signs are within normal limits. He is able to ambulate in the emergency department without significant issues, and there are no obvious skin breakages or significant bony deformities. You note that his left leg is significantly swollen compared to the right leg and there is evidence of pitting oedema and erythema. Passive dorsiflexion of his left foot leads to significant pain.
What is the next best step in the management of this patient?
MRCP2-2284
A 50-year-old man has been diagnosed with renal cell carcinoma and is scheduled for a nephrectomy in four days. He presents with a suddenly swollen and tender left calf, and an ultrasound confirms a deep vein thrombosis extending to the femoral vein. What is the most appropriate course of action for management?
MRCP2-2285
You are asked to evaluate a 69-year-old male who is experiencing coffee ground vomiting while on the oncology ward. He has a history of colorectal cancer and is currently undergoing curative chemotherapy.
The patient’s blood results are as follows:
– Hb 95 g/l
– Platelets 34 * 109/l
– WBC 14 * 109/l
– PT ratio 2.4
– aPTT ratio 2.1
– D-dimer 1540 ng/ml (normal < 500)
– Fibrinogen 0.8 g/l (normal 1.5-4.0)
You administer fresh frozen plasma, and the repeat blood results are as follows:
– Hb 91 g/l
– Platelets 24 * 109/l
– WBC 18.4 * 109/l
– PT ratio 2.2
– aPTT ratio 1.9
– Fibrinogen 0.85 g/l (normal 1.5-4.0)
What is the appropriate treatment for this patient?