Archives: MRCP Part 2

MRCP2-2214

A 42-year-old man presents to the Emergency Department with a 4-week history of left lower leg pain and swelling. On examination, his left calf is enlarged and tender to touch. He denies chest pain or shortness of breath.
There is no past medical history of note and he takes no regular medication after recently switching from the combined oral contraceptive pill to the intrauterine coil one month ago.
Further investigations were ordered:

Haemoglobin 142 g/l 135–175 g/l
Platelets 320 × 109/l 150–450 × 109/l
D-dimer 1200 ng/ml < 400 ng/ml
Fibrinogen 2.3 g/l 2–4 g/l
Prothrombin time 11 seconds 10–14 seconds
Factor V Leiden Positive
What is the next step in the management of this patient?

MRCP2-2215

A 28-year-old Afro-Caribbean woman presents to the hospital with a three-day history of increasing pain and swelling in her left leg. She has also developed a low-grade fever over the past 24 hours. There is no recent history of trauma, immobilization, or prolonged travel by land or air. Two years ago, she was admitted with a similar episode of pain and swelling in her right calf, which was confirmed to be a deep vein thrombosis on Doppler scanning. She is married, works on a production line for a television company, and is a non-smoker and non-drinker. Her only medication is an antidepressant prescribed by her GP after a miscarriage six months ago. Her relationship with a previous partner ended after she miscarried his child.

Investigations reveal a hemoglobin level of 105 g/L (115-165), MCV of 94 fL (80-96), WCC of 7.5 ×109/L (4-11), platelets of 95 ×109/L (150-400), normal protein C and protein S activity, and a positive VDRL of 1:8.

What is the likely diagnosis?

MRCP2-2216

A 28-year-old woman presents to the hospital with a fever, five days after completing a cycle of chemotherapy for lymphoma. Upon examination, she appears unwell and is febrile at 39.5°C. Her pulse is 120 beats per minute, regular, and her blood pressure is 85/40 mmHg. Heart sounds are normal with no added sounds or murmurs. Her chest is clear on auscultation and her abdomen is soft and non-tender.

The following investigations were conducted:
– Haemoglobin: 112 g/L (130-180)
– White cell count: 2.0 ×109/L (4-11)
– Neutrophils: 0.2 ×109/L (1.5-7)
– Lymphocytes: 1.6 ×109/L (1.5-4)
– Monocytes: 0.15 ×109/L (0-0.8)
– Eosinophils: 0.04 ×109/L (0.04-0.4)
– Basophils: 0.01 ×109/L (0-0.1)
– Platelets: 151 ×109/L (150-400)

What is the recommended treatment for this patient?

MRCP2-2217

A 68-year-old man presents with symptomatic anaemia. On examination, he is jaundiced and has generalised lymphadenopathy with moderate hepatosplenomegaly.

His investigations are given below:

– Haemoglobin 81 g/L (135 – 180)
– Mean corpuscular volume 108 fL (80 – 100)
– White cell count 14.6 ×109/L (4 – 11)
– Neutrophils 3.2 ×109/L (1.5 – 7.4)
– Lymphocytes 7.0 ×109/L (1.1 – 4.0)
– Bilirubin 34 mg/L (1-22)
– LDH 560 IU/L –
– Direct Coombs’ test positive with IgG
– Blood smear: Spherocytosis, lymphocytosis and smear cells.

What is the most likely cause of his anaemia?

MRCP2-2218

A 68-year-old man with a history of CLL presents to the Emergency Department with difficulty breathing, three weeks after receiving a blood transfusion for haemolytic anaemia. His haemoglobin has dropped from 100 g/l at discharge to 61g/l today. He has been undergoing Fludarabine therapy for several months. What is the main underlying cause of Autoimmune Haemolytic Anaemia (AIHA) in patients with CLL?

MRCP2-2219

A 65-year-old male presents with fatigue and loss of appetite. He had a partial gastrectomy 2 years ago for a bleeding gastric ulcer. His laboratory results reveal:

– Hemoglobin (Hb): 90 g/l
– Mean corpuscular volume (MCV): 109 fL
– Platelets: 60 * 109/l
– White blood cells (WBC): 3.5 * 109/l
– Blood film: Oval erythrocytes, macrocytic erythrocytes, hypersegmented neutrophils, low platelets, and basophilic stippling

What is the probable underlying 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?