MRCP2-2181
In hyperthermia, as the body temperature rises, what is the earliest biochemical abnormality observed?
Archives: MRCP Part 2
MRCP2-2182
A 79-year-old woman attends the memory clinic with her daughter due to a 7-month history of memory loss. She reports feeling well today, but her daughter explains that last week she was confused and disoriented. Her daughter also expresses concern that her mother may be hallucinating as she has mentioned seeing her deceased husband sitting at the dinner table with her. The patient has a history of osteoarthritis and borderline diabetes but has been otherwise healthy with no recent illnesses.
During the examination, her heart rate is 86 bpm and regular. Her sitting and standing blood pressures are 152/95 mmHg and 138/86 mmHg respectively. On auscultation, her chest is clear with normal heart sounds. Her abdomen is soft with no palpable masses. There is a slight tremor in her left hand with increased rigidity. She walks well with a walking stick but has a shuffling gait. Her MMSE score is 20/30.
Based on the likely diagnosis, what is the most appropriate treatment to initiate?
MRCP2-2183
An 81-year-old man presents to a memory clinic with concerns about his memory. His wife has noticed changes in his memory and has requested an evaluation for dementia. She reports that he forgets where he is, forgets things in the middle of conversations, responds to things that are not there, and has reported seeing things. However, at other times, he is able to have normal conversations. The patient has a history of prostate cancer managed with hormone therapy, COPD, hypertension, and osteoarthritis. He has no recent changes in medication and quit smoking 20 years ago. He used to drink heavily but has been sober for five years. On examination, the patient is alert and oriented with a slight tremor in his left hand and increased muscle tone.
What is the most likely diagnosis?
MRCP2-2184
You are working in General Practice when a 70-year-old woman is brought in by her concerned daughter. She reports that her mother has been displaying unusual behavior lately, such as calling her in the middle of the night and believing that strangers are in the house. The patient also seems disoriented with time and often prepares for bed during the day. The daughter notes that some days her mother appears completely lucid.
Upon further questioning, the patient is aware of her surroundings but tends to ramble and go off-topic. She admits to experiencing visual hallucinations, including a cat that has been following her for several months. She also mentions feeling generally slower over the past year.
The patient’s current medications include rivaroxaban for atrial fibrillation and amitriptyline for fibromyalgia. Upon reviewing her medical records, you notice that she has been brought in multiple times over the past six months with similar complaints and has been prescribed antibiotics for a suspected UTI each time.
What is the most likely underlying cause of the patient’s presentation?
MRCP2-2185
A 70-year-old woman is being evaluated at the memory clinic for worsening dementia and coexisting Parkinson’s disease, which is being treated with levodopa. On objective testing, she is found to have mild cognitive impairment. What medication should be recommended to alleviate her cognitive symptoms?
MRCP2-2186
A 48-year-old woman has been referred to the Cardiology Clinic by her GP for an opinion on atrial fibrillation. She has been experiencing increasing fatigue for the past few months and was diagnosed with AF by her GP. During examination, she presents with a small-volume pulse, DJV, left parasternal lift, a tapping apex impulse, and a loud first heart sound accompanied by a mitral early- to mid-diastolic murmur. Additionally, there seems to be a mid-diastolic tricuspid murmur. What is the appropriate diagnosis for this clinical presentation?
MRCP2-2187
A 75-year-old man was brought to the hospital after collapsing. A caregiver at his nursing home reported that he became pale and unresponsive in a chair but regained consciousness after a few minutes. The patient has a medical history of hypertension, hypothyroidism, mild dementia, and a previous seizure 10 years ago.
Upon examination, the paramedics noted a heart rate of 34/min, which has since resolved. The patient’s heart sounds are normal, capillary refill is 3 seconds, and his pulse is regular at 60/min. Which medication(s) could have caused the collapse?
MRCP2-2188
A 70-year-old man with memory problems attended a specialist memory clinic with his son. His son was very concerned and mentioned that his father had been much more forgetful over the past year. He had left the front door open and occasionally got lost when he drove to the grocery store. On one occasion he had been found by a police officer wandering the streets in his pajamas.
This man had a family history of Alzheimer’s disease with both his father and brother being diagnosed with the condition in their seventies.
On examination he had a Mini Mental State Examination Score of 20/30. Otherwise a full physical examination was unremarkable.
Magnetic resonance of imaging of the brain showed marked atrophy of the medial temporal lobes bilaterally with no evidence of a reversible cause of dementia.
You suspect that this man has Alzheimer’s disease and wish to start him on donepezil.
Before starting him on this medication which of the following should you arrange?
MRCP2-2189
A 70-year-old man is admitted to the hospital with confusion. He has a medical history of hypertension, Parkinson’s disease, and hypercholesterolemia. He takes co-careldopa, amlodipine, and atorvastatin. He lives alone and is independent.
Vital signs:
Heart rate: 101 beats per minute
Blood pressure: 120/77 mmHg
Respiratory rate: 20/minute
Oxygen saturations: 97% on room air
Temperature: 37.8ºC
During the examination, suprapubic tenderness is noted. The Glasgow coma scale is 14/15.
The patient is treated with antibiotics for a presumed urinary tract infection. Although he clinically and biochemically improves, he remains confused after 3-4 days of admission. Other causes of delirium are ruled out. He becomes increasingly agitated and poses a risk to himself and other patients, despite conservative measures to re-orient him.
What is the most appropriate medication choice given the patient’s clinical history?
MRCP2-2190
An 80-year-old woman is admitted to the acute medical unit with abdominal pain, swelling and confusion. She has a medical history of Parkinson’s disease, recurrent urinary tract infections and hypertension. She is currently taking amlodipine, co-careldopa and doxazosin. She resides in a care home and is usually pleasant and talkative with no history of memory problems. However, her behavior is out of character. Her observations are heart rate 88 beats per minute, respiratory rate 18/minute, oxygen saturations 97% on room air, blood pressure 145/88 mmHg and temperature 37.1ºC.
Upon examination, impacted faeces in the rectum and mild suprapubic tenderness are noted. She is inattentive and confused, and her cognition fluctuates. A unilateral resting tremor and mild bradykinesia are also observed. Urinalysis showed leucocytes +++ and nitrites +. An ECG is unremarkable. Blood tests reveal elevated CRP levels, but they normalize after treatment with antibiotics for a presumed urinary tract infection and laxatives and suppositories for constipation.
Despite these interventions, the patient remains confused, agitated and inattentive, posing a danger to herself and other patients on the ward. Given the likely diagnosis, what is the most appropriate pharmacological management?