Archives: MRCP Part 2

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?

MRCP2-2256

A 35-year-old woman presented with a 3-month history of excessive night sweats and a weight loss of 8 kg. During the medical history, she denied any recent travel, diarrhea, or persistent cough.
Upon clinical examination, a 2.5 cm lymph node was found in the left supraclavicular fossa. No hepatosplenomegaly was observed.
The following investigations were conducted:
Haemoglobin (Hb) 118 g/l 135 – 175 g/l
White cell count (WCC) 4.8 × 109/l (90% neutrophils, 5% eosinophils) 4.0 – 11.0 × 109/l
Platelets (PLT) 170 × 109/l 150 – 400 × 109/l
Chest X-ray Mediastinal mass (6 cm)
Abdominal ultrasound Normal
What is the most probable diagnosis?

MRCP2-2225

The following panel results were seen for a blood transfusion recipient and the donor unit of blood.

Donor sample is positive for the following antibodies:
– Anti A positive
– Anti B positive
– Anti rhesus positive

Recipient is positive for the following antibodies:
– Anti-A positive
– Anti-B negative
– Anti rhesus negative

What is the age of the recipient?

MRCP2-2226

You are asked to attend to a 50-year-old man who is receiving a blood transfusion for symptomatic anaemia caused by colon cancer. The nursing staff has been monitoring his vital signs and has recorded the following observations:

10:00 am: Initial vital signs before the blood transfusion

Respiratory rate: 20 breaths/min
Saturations: 96% on air
Temperature: 37.5 ºc
Blood pressure: 145/78 mmHg
Heart rate: 74 beats/min

10:15 am: Vital signs after 15 minutes of transfusion

Respiratory rate: 19 breaths/min
Saturations: 97% on air
Temperature: 38.2 ºc
Blood pressure: 150/80 mmHg
Heart rate: 72 beats/min

The blood transfusion has already been stopped by the nursing staff before you arrive to assess the patient. Upon questioning, the patient reports feeling well and has no complaints of pain, itching, or rashes. During your examination, you note clear heart sounds and lungs. The patient has no known history of blood transfusion reactions, but he does mention being allergic to penicillin. What instructions do you provide to the nursing staff?

MRCP2-2227

A 25-year-old woman comes to the clinic with sudden abdominal distension. Upon biopsy of an abdominal mass, it is revealed that she has B cell lymphoblastic lymphoma with a high rate of cell division. What cytogenetic abnormality is typically observed in this type of lymphoma?

MRCP2-2228

A 40-year-old man presented to his GP with fatigue. Investigations reveal low haemoglobin, low serum ferritin, and normal white cell count and platelets. He was prescribed iron sulphate tablets for presumed iron deficiency anaemia and referred to the Outpatient Clinic. However, he still feels fatigued and reports numbness and tingling in his lower limbs. He had a previous operation on his abdomen while abroad for severe abdominal pain and upper GI haemorrhage, but cannot recall the specifics. Examination shows pale conjunctiva, a lemon-yellow tinge to his skin, slight distal lower limb sensory loss, absence of ankle jerks, and exaggerated knee reflexes. Abdominal examination shows a longitudinal median scar, but no organomegaly. Repeat investigations reveal low haemoglobin, low mean corpuscular volume, and normal white cell count and platelets. Which operation is he most likely to have had?

MRCP2-2229

A 68-year-old man is seen in the haematology clinic for the second time. His first review was six months previously.

His full blood count shows:

Haemoglobin 120 g/L (115 – 165)

White cell count 80 ×109/L (4 – 11)

Neutrophils 4.5 ×109/L (1.5 – 7)

Lymphocytes 73 ×109/L (1.5 – 4)

Monocytes 0.3 ×109/L (0 – 0.8)

Eosinophils 0.04 ×109/L (0.04 – 0.4)

Basophils 0.06 ×109/L (0 – 0.1)

Platelet count 390 ×109/L (150 – 400)

His white cell count six months previously had been 45 ×109/L. He is feeling well.

What is the recommended management plan for this patient at this stage?

MRCP2-2230

A 75-year-old woman presents with recurrent lower respiratory tract infections. She has been prescribed antibiotics three times by her GP in the past six months. She has no history of asthma or COPD and denies sputum production between infections. Her blood test results show Hb 101 g/L (115-165), WCC 29 ×109/L (4-11), Neutrophils 4 ×109/L (1.5-7), Lymphocytes 22 ×109/L (1.5-4), and Platelets 180 ×109/L (150-400). The blood film is normochromic and normocytic with evidence of polychromasia. Which investigation would provide the most information?

MRCP2-2231

A 65-year-old woman presents to the haematology clinic after an incidental lymphocytosis was noted by her GP four months ago. She reports feeling more fatigued and experiencing early satiety, which she attributed to looking after her grandchildren. On examination, there is a fullness in the left upper quadrant, and blood tests reveal lymphocytosis with smudge cells and splenomegaly confirmed by ultrasound. Chromosomal analysis is performed to guide further management. If the likely diagnosis is confirmed, which chromosomal finding would indicate a poor prognosis?

MRCP2-2232

A 67-year-old woman with a history of CLL and a deletion of the short arm of chromosome 17 (17p) presents to haematology clinic with cervical lymphadenopathy and splenomegaly. Her blood tests reveal elevated WBC count, low neutrophil count, and high lymphocyte count. Among these clinical features, which one is associated with the poorest prognosis for this patient?