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?

MRCP2-2209

A 54-year-old woman presents to her GP with concerns from her carer about her increasingly prominent gums over the past few months. The patient has learning difficulties and lives in a care home. She has had three recent infections and has been experiencing fatigue and shortness of breath with minimal activity. On examination, she has hypertrophic bleeding gums, anaemia, multiple bruises, a flow murmur, and mild splenomegaly. Blood tests reveal a raised white cell count, low neutrophil count, thrombocytopenia, and increased blast cells with Auer rods. What is the most likely diagnosis?

MRCP2-2210

A 45-year-old man presents to the Emergency Department with non-specific symptoms of lethargy, malaise, headache, body aches, a low-grade fever and a sore throat. The examination is essentially normal aside from multiple limb petechiae. Tympanic temperature is 37.6°C. Blood pressure, heart rate and pulse oximetry are normal.

Blood tests show:

Haemoglobin 112g/L Sodium 136 mmol/L
MCV 82fL Potassium 4.5 mmol/L
Platelets 77×10^9/L Urea 6.9mmol/L
White cells 32×10^9/L Creatinine 111µmol/L
Prothrombin time 23 secs CRP 54 mg/L
Fibrinogen 0.45g/L HIV test Negative
Liver enzymes normal

The automated counter is unable to supply differential white cell count.

Manual blood film shows immature granulocytes with bilobed nuclei and Auer rods.

What is the most important immediate therapy to initiate?

MRCP2-2211

A 35-year-old man with acute myeloid leukaemia undergoes a bone marrow transplant from a matched unrelated donor. After 7 days, he develops a non-blanching purpuric rash on both legs. The rash is not itchy or scaly, and he has no other symptoms except for a heart rate of 98/min and blood pressure of 124/72 mmHg. His temperature is 37.3 ºC. Blood tests reveal low levels of platelets and white blood cells, as well as elevated CRP. Based on these findings, what is the most likely cause of the rash?

MRCP2-2212

A 42-year-old man with human immunodeficiency virus (HIV) presents to clinic six weeks after starting highly active antiretroviral therapy (HAART). He had been feeling well before starting therapy, but over the past two weeks has been experiencing increasing fatigue and weakness. He also reports difficulty breathing during physical activity.
He denies having a fever, chest pain, or cough. He has no significant medical history and is currently taking tenofovir, emtricitabine, and dolutegravir, along with co-trimoxazole for prophylaxis against Pneumocystis jirovecii pneumonia.
The following results are obtained from his tests:
Test Pre-treatment After six weeks Normal Value
Haemoglobin (Hb) 135 g/l 89 g/l 130–170 g/l
Mean corpuscular volume (MCV) 92 fl 100 fl 80–100 fl
CD4 count 220 280 500–1500
Haptoglobin 800 mg/l 820 mg/l 400–1600 mg/l
What is the most probable cause of the patient’s anemia?