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?

MRCP2-2250

A 50-year-old man presents to his GP with worsening back pain that has been present for a few months and is no longer relieved with analgesia. He reports feeling constantly tired and has a reduced appetite with associated weight loss, which he had attributed to the analgesics he was taking. The patient had been treated successfully for stage IA Hodgkin’s lymphoma five years ago. On clinical examination, there are positive findings of axillary and inguinal lymphadenopathy, 6 cm splenomegaly, and tenderness along the length of his lumbar spine. Investigations reveal abnormal results for haemoglobin, white cell count, neutrophils, and platelets. What further investigation would you perform to confirm the diagnosis?

MRCP2-2251

A 59-year-old man presents to the hospital after being referred by his GP. He reports experiencing progressive weakness and breathlessness on exertion for the past two weeks, as well as symptoms of indigestion. Upon examination, he appears pale and tachycardic, with a blood pressure of 110/70 mmHg. His heart sounds are normal and his chest is clear. The patient brings in blood test results from his GP, which show a low haemoglobin level, low mean corpuscular volume, and abnormal red blood cell morphology. Which test would be most useful to measure in this patient?

MRCP2-2252

A 68-year-old man presents with increasing fatigue and low back pain for the past five months.Clinical examination reveals a pale-looking man who is slim, with a body mass index (BMI) of 20.5. Blood tests reveal a mild normocytic, normochromic anaemia, low white cell and platelet counts and a high ESR. Blood urea, electrolytes and serum alkaline phosphatase levels are normal, and liver function testing reveals raised total protein and globulin fraction. An X-ray of the lumbosacral spine shows lytic lesions.Which of the following investigations would be most helpful in confirming the diagnosis?

MRCP2-2253

A 35-year-old man presents with sudden fatigue and difficulty breathing. He reports injuring his foot on a rusty nail and noticing a red, spreading area around the wound. Two days later, he began experiencing chills and was brought to the hospital by his family.

During the examination, the patient appears pale and sweaty with a capillary refill time of 4 seconds. His chest is clear, but he is breathing rapidly and shallowly. His heart rate is 123 beats per minute and regular, while his blood pressure is 85/65 mmHg. The wound on his foot is now raised and discolored, with pus collecting under the skin. His cannula site is also bleeding. He is given three liters of intravenous fluid and started on vancomycin and gentamicin.

Hemoglobin: 130 g/L
Platelets: 110 * 10^9/L
White blood cells: 34.0 * 10^9/L
C-reactive protein: 459 ng/mL
Prothrombin time: 18 seconds
Activated partial thromboplastin time: 45 seconds
Fibrinogen: 0.1 g/L
Chest X-ray: patchy bilateral infiltrates
Wound swab: Streptococcus pyogenes

What is the cause of the patient’s abnormal coagulation?

MRCP2-2254

A 54-year-old man presents to the Emergency Department with sudden onset of fatigue and difficulty breathing. He was recently diagnosed with non-Hodgkin’s lymphoma and completed chemotherapy. On examination, he has bilateral crackles in his chest and his blood pressure is 100/70 mmHg with a pulse of 100 bpm. The following laboratory results were obtained: Hb 59 g/l, reticulocytes 0.5%, WCC 6.7 × 109/l, PLT 202 × 109/l, Na+ 137 mmol/l, K+ 4.9 mmol/l, and creatinine 110 µmol/l. What is the most likely cause of his anaemia?

MRCP2-2255

A 68-year-old man presents with severe intractable back pain, headaches, and lethargy. He recently had left lower lobe pneumonia and his symptoms have significantly worsened over the past few days. He is unable to keep any food or fluids down and is vomiting several times during the day. On examination, his BP is 160/95 mmHg and he looks pale. His pulse is 88/min and regular and there are bilateral crackles on auscultation of the chest. Investigations reveal a low haemoglobin level, high potassium and creatinine levels, and positive P-ANCA. What is the most likely diagnosis?