Archives: MRCP Part 2

MRCP2-2233

A 35-year-old Cypriot woman visits her primary care physician for a routine check-up. She reports feeling healthy and works long hours as a software engineer.
Her medical history includes mild high blood pressure, for which she has been advised to make lifestyle changes and lose weight.
The following tests were conducted:
Test Result Normal Range
Hemoglobin (Hb) 70 g/l (MCV 68; target cells) 135–175 g/l
White blood cell count (WBC) 4.9 × 109/l 4.0–11.0 × 109/l
Platelets (PLT) 190 × 109/l 150–400 × 109/l
Sodium (Na+) 140 mmol/l 135–145 mmol/l
Potassium (K+) 5.0 mmol/l 3.5–5.0 mmol/l
Creatinine (Cr) 130 µmol/l 50–120 µmol/l
HbF Slightly elevated (5%)
HbA2 4%
Fecal occult blood positive
What is the most probable diagnosis?

MRCP2-2234

A 25-year-old female nurse presents with prolonged bleeding after a minor surgical procedure. It has been three days since the procedure, and the bleeding has not stopped: she has noticed dark stools on two separate occasions.
Past medical history includes a postoperative haemorrhage following an appendectomy, that required a blood transfusion. She has one sister who is healthy and believes her grandmother may have died of bleeding after a fall.
On examination, she appears pale but her perfusion is adequate. Rectal examination confirms the presence of melaena.
Investigations reveal the following:

Haemoglobin (Hb) 78 g/l 120–160 g/l
Prothrombin Test (PT) 26 s 11.0–14.0 s
Partial Thromboplastin Time (PTT) 35 s 25.0–35.0 s
Fibrinogen 210 mg/dl 150–400 mg/dl
Mixing studies with 50;50 test normal plasma shows complete correction of PT
What possible diagnosis should be considered at this stage pending further investigation?

MRCP2-2235

A 62-year-old woman complains of sudden vision loss in her right eye, without any associated eye discomfort. Upon retinal examination, flame haemorrhages are observed in one quadrant. The patient has a medical history of hypertension and is currently undergoing investigations for anaemia, with a recent haemoglobin level of 105 g/l. What is the most likely diagnosis based on these findings?

MRCP2-2236

An elderly man, aged 75, complains of intense abdominal pains and constipation following his initial round of R-CHOP chemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone). Which medication is likely responsible for these symptoms?

MRCP2-2237

A 28-year-old male patient has been referred to the clinic due to a history of recurrent chest infections over the past ten years. The patient has been diagnosed with common variable immunodeficiency. Laboratory investigations have revealed the following results: IgG 6.5 g/L (6.0-13.0), IgA 0.8 g/L (0.8-3.0), and IgM 0.5 g/L (0.4-2.5). What is the best option to prevent further recurrent chest infections?

MRCP2-2238

An 80-year-old woman is admitted to the hospital for a right hemicolectomy due to carcinoma of the caecum. She has a history of osteoarthritis and had a fibroma removed from her right breast two years ago. She is a non-smoker and drinks approximately 8 units of alcohol per week. Pre-operative investigations show a low Hb and MCV, but normal WCC and platelets. The procedure goes smoothly, but three days later she becomes jaundiced and complains of fatigue. postoperative investigations show a further drop in Hb and an increase in MCV, WCC, and platelets. What is the best investigation to confirm the diagnosis?

MRCP2-2220

A 30-year-old male Caucasian presents to the emergency department with severe anaemia. His GP requested him to come to the hospital after noticing his recent community blood tests. The patient reported feeling increasingly tired and experiencing shortness of breath on exertion. He has no significant medical history except for an appendectomy at the age of 20. Recently, he has been exercising more to lose weight and has been taking diclofenac regularly for severe muscle aches. On examination, he appears mildly jaundiced, but there are no signs of liver disease, and his abdomen is soft without tenderness. Blood tests show spherocytosis, and further investigations are pending. What is the most likely diagnosis?

MRCP2-2221

An 80-year-old man with atrial fibrillation who is taking warfarin presents to the Emergency department with massive haematemesis. His blood count reveals a normal platelet count of 190 ×109/L, an APTT ratio of 1.6, and an INR of >10. What is the most suitable way to reverse warfarin in this scenario?

MRCP2-2222

A 30-year-old woman has been diagnosed with chronic kidney disease and is experiencing iron deficiency. She is scheduled to begin intravenous iron treatment along with an ESA. She has no history of hypersensitivity or anaphylaxis. Today, she arrives for her first infusion. What is the best course of action to take?

MRCP2-2223

A 50-year-old man presented to the outpatient clinic with anaemia. He had been experiencing fatigue and low back pain for the past three months, without any history of trauma. A plain x-ray of his lumbar spine revealed a lytic lesion in the body of the fifth lumbar vertebra (L5). Further investigations showed a haemoglobin level of 105 g/L (130-180), WBC count of 4.0 ×109/L (4-11), platelet count of 175 ×109/L (150-400), and serum corrected calcium level of 2.4 mmol/L (2.2-2.6). Bence Jones proteins were detected in his urine, and a skeletal survey showed increased uptake in the L5.

Which of the following treatments would be effective in reducing the risk of pathological fracture?