Archives: MRCP Part 2

MRCP2-2271

A 35-year-old male presents with a rash and low-grade fever (37.6°C) three weeks after receiving an allogeneic bone marrow transplant for high-risk acute myeloid leukemia in first complete remission. Initially, the rash is maculopapular and affects his palms and soles. However, after 24 hours, general erythroderma is noted on his trunk and limbs. Although his total bilirubin was previously normal, it is now 40 µmol/L (1-22). Despite these symptoms, he remains in good health. What would be the appropriate management for this patient at this stage?

MRCP2-2272

A 50-year-old woman is being evaluated before undergoing a hysterectomy and oophorectomy. She has no family history of bleeding or thrombosis, and has not experienced any post-traumatic or post-surgical bleeding (although she has had an appendicectomy and tonsillectomy in the past). Additionally, she is not taking any anti-thrombotic or anticoagulant medication. What is the appropriate method for assessing her risk of bleeding prior to surgery?

MRCP2-2273

Is there a current trend of excessive thrombophilia testing in various situations where it has been proven unnecessary?
At what age should clinicians consider screening for thrombophilia in specific clinical scenarios?

MRCP2-2274

A 35-year-old woman has been diagnosed with placenta praevia and is experiencing bleeding from the cannulation site during caesarean delivery. Her laboratory results indicate a platelet count of 40 ×109/L, a fibrinogen level of 0.4, prolonged PT at 14 seconds, and an elevated quantitative D-dimer. What is the most useful parameter to determine if this patient needs active treatment?

MRCP2-2239

A 42-year-old woman presents to her primary care physician with a 10-day history of intermittent nosebleeds. She has never experienced this before, but now reports that even after blowing her nose, the bleeding persists for 2-3 minutes. She has a medical history of hypothyroidism and takes levothyroxine 75 micrograms daily. She recently recovered from the flu but has had no other illnesses.

During the examination, the patient’s vital signs are stable, and there are no abnormalities in her chest or abdomen. However, there are multiple bruises and petechiae on her lower limbs and trunk.

The following investigations were conducted:

– Hemoglobin: 116 g/L (normal range for females: 115-160 g/L)
– Platelets: 16 * 109/L (normal range: 150-400 * 109/L)
– White blood cells: 5.1 * 109/L (normal range: 4.0-11.0 * 109/L)
– Sodium: 136 mmol/L (normal range: 135-145 mmol/L)
– Potassium: 3.5 mmol/L (normal range: 3.5-5.0 mmol/L)
– Urea: 5.0 mmol/L (normal range: 2.0-7.0 mmol/L)
– Creatinine: 61 µmol/L (normal range: 55-120 µmol/L)
– Prothrombin time (PT): 12 secs (normal range: 10-14 secs)
– Activated partial thromboplastin time (APTT): 28 secs (normal range: 25-35 secs)
– Fibrinogen: 2.6 g/L (normal range: 2-4 g/L)
– D-Dimer: 254 ng/mL (normal range: < 400 ng/mL) What is the most appropriate next step in managing this patient?

MRCP2-2240

A 27-year-old man presents to the dental hospital for a tooth extraction. During his medical history, he mentions experiencing prolonged bleeding after a tooth extraction two years ago. He denies any other surgical complications and reports being in good health. However, upon further questioning, he reveals that his mother has been referred to a local hospital for recurrent nose bleeds and menorrhagia, and his sister has a history of menorrhagia. Despite the patient’s increased risk of bleeding, the dental extraction cannot be postponed. What medication should the dentist prescribe to minimize the risk of significant bleeding?

MRCP2-2241

A 72-year-old man presents for his annual check-up and his full blood count reveals a mild lymphocytosis of 15 ×109/L. He is not experiencing any symptoms. What is the most crucial test to confirm a diagnosis of chronic lymphocytic leukemia (CLL)?

MRCP2-2242

An 83-year-old woman presented to her doctor with severe back pain that had been ongoing for two months. She had been feeling unwell for a few weeks and had lost weight, but was unsure of the amount. Her medical history included well-controlled angina with atenolol and isosorbide mononitrate, and she had quit smoking eight years ago after smoking 40 cigarettes per day. She lived alone in a monitored flat and had been struggling to perform daily tasks due to the pain. She was admitted to the hospital due to the severity of the pain and investigations revealed various abnormalities. What would be the most appropriate treatment to manage her back pain?

MRCP2-2243

A 28-year-old electrician presents to his primary care physician with gum swelling and fatigue. Previously healthy, he has noticed bleeding from his gums and easy bruising over the past week. He does not take any medications, smoked 8 cigarettes daily, and drinks up to 18 units per week.

During the examination, the physician observes significantly swollen gums, enlarged lymph nodes in the neck and groin, and 4-cm hepatosplenomegaly. The patient’s vital signs are within normal limits. Fundoscopy reveals dilated retinal veins and multiple retinal hemorrhages.

Further investigations reveal the following results:
– Hemoglobin (Hb): 68 g/l (normal range: 135-175 g/l)
– White cell count (WCC): 420.5 × 109/l (normal range: 4.0-11.0 × 109/l)
– Platelets (PLT): 5.5 × 109/l (normal range: 150-400 × 109/l)
– Blood film: Heavy infiltration of blasts with monocytoid features
– Serum lysozyme: 70 mg/l (normal range: 4-13 mg/l)
– Activated partial thromboplastin clotting time (APTT): 44 s (normal range: 25-35 s)

What is the necessary step to establish a diagnosis in this patient?

MRCP2-2244

A 29-year-old Afro-Caribbean male presents for a routine insurance examination. During questioning, he reports feeling frequently tired and sleeping in the evenings. He also mentions experiencing bleeding gums and several recent episodes of nosebleeds. Although he does not smoke, he admits to consuming 22 units of alcohol per week.

Upon examination, the patient appears pale, but no other abnormalities are noted. Further investigations reveal a hemoglobin level of 80 g/L (130-180), a hematocrit of 0.24 (0.40-0.52), an MCV of 88 fL (80-96), a white cell count of 2 ×109/L (4-11), and platelets of 40 ×109/L (150-400). The peripheral blood film shows normocytic hypochromic erythrocytes.

What is the most likely diagnosis?