Archives: MRCP Part 2

MRCP2-2171

A 44-year-old man presents to neurology outpatients with a 2-month history of disinhibited behaviour. His family reports that he has been urinating in public and has been brought home by the police twice recently. He has also been experiencing weight loss over the past year, going from 110 kg to 92 kg. He complains of pain in his lower back, right knee, and left ankle, and has been having diarrhea that is difficult to flush and smells bad.

On examination, he appears pale and has angular cheilitis. His abdomen is distended with some shifting dullness, but no palpable organomegaly is present. He has a positive palmo-mental reflex, and his right knee and left ankle are swollen with minimal tenderness and good range of motion.

Lab results show a low albumin level, low hemoglobin, and an elevated platelet count. A CT scan of the brain is normal, but a duodenal biopsy reveals expanded villi containing macrophages staining positive with periodic acid–Schiff stain.

What is the most likely diagnosis?

MRCP2-2172

A 52-year-old man presents to the outpatient clinic with complaints of weight loss and abdominal pain for the past eight months. He describes the pain as generalised and associated with bloating. He has also noticed an increase in bowel frequency and loose stools. He has lost approximately 10 kg in weight despite having a good appetite. The patient has a history of intermittent knee pain and occasional night sweats. He is a non-smoker and consumes 30-40 units of alcohol per week. On examination, he is thin with diffuse abdominal tenderness and palpable lymph nodes in his neck, axillae, and groins. Investigations reveal low haemoglobin, low albumin, and negative stool culture. What is the most appropriate treatment for this patient?

MRCP2-2173

A 55-year-old woman has been diagnosed with Wilson’s disease. As you review her blood test results, which of the following would you anticipate finding in a patient with this condition?

MRCP2-2174

A 19-year-old woman who works as a teaching assistant in a nursery has been experiencing shaking in her right arm when writing on the blackboard and has been dropping cups of tea due to shaking. She has also noticed poor balance and falls easily when playing with the children. These symptoms have developed gradually over the course of 15 months. During her neurological examination, a postural tremor of the upper limbs was observed, with the right side being worse than the left. Additionally, she has a broad-based ataxic gait and some rigidity in her right upper limb. The slit lamp examination revealed brown-green deposits in Descemet’s membrane of the cornea. The rest of the clinical examination was unremarkable. What is the most appropriate treatment for the underlying condition?

MRCP2-2140

A recuperating alcoholic patient admitted to the ward has developed confusion after two days. Additionally, he complains of experiencing difficulty standing up from a sitting position and increasing shortness of breath. Upon further inquiry, it is discovered that he typically consumes 5-6 pints of medium strength lager daily, but his last drink was 7 days ago. He has a poor diet and smokes 30 rolled up cigarettes every day. During the examination, it is observed that his chest is clear, but he has generalised muscle weakness. What test is most likely to reveal the underlying abnormality?

MRCP2-2141

A 35-year-old woman with a history of heavy smoking presents to the clinic with increased abdominal swelling. She has noticed increasing abdominal girth over the past 4-6 months.
On examination, there are signs of chronic lung disease, including wheezing and shortness of breath, and she also has a persistent cough. Her BP is 110/70 mmHg.
Investigations:
s
Haemoglobin (Hb) 120 g/l 135 – 175 g/l
Mean corpuscular volume (MCV) 90 fL 80 – 100 fl
White cell count (WCC) 6.2 × 109/l 4.0 – 11.0 × 109/l
Platelets (PLT) 250 × 109/l 150 – 400 × 109/l
Sodium (Na+) 138 mmol/l 135 – 145 mmol/l
Potassium (K+) 4.2 mmol/l 3.5 – 5.0 mmol/l
Creatinine (Cr) 75 µmol/l 50 – 120 µmol/l
CA-125 75 u/ml < 35 u/ml
What is the most likely cause for the increased CA-125?

MRCP2-2142

A 62-year-old woman presents with difficulty swallowing both solids and liquids, as well as a persistent nighttime cough and noticeable bad breath. She has been experiencing these symptoms for some time and is particularly self-conscious about them as she has recently started dating again. She has even woken up to find undigested food on her pillow, which she finds disgusting. Although she occasionally experiences acid reflux, she does not believe it is the primary issue. She smokes five cigarettes per day and drinks a glass of wine each evening.

During the physical examination, her BMI is 29 and her blood pressure is 146/94 mmHg. All other aspects of the physical examination are unremarkable.

The following investigations were conducted:

Haemoglobin 130 g/l 135–175 g/l
White cell count (WCC) 6.2 × 109 /l 4–11 × 109/l
Platelets 220 × 109 /l 150–400 × 109/l
Sodium (Na+) 142 mmol/l 135–145 mmol/l
Potassium (K+) 4.3 mmol/l 3.5–5.0 mmol/l
Creatinine 135 µmol/l 50–120 µmol/l
Plasma Viscosity 1.5 mPa/s 1.5-1.72 mPa/s

Which investigation is most likely to confirm the diagnosis?

MRCP2-2143

A 19-year-old male student is presenting with weight loss and diarrhoea. These symptoms have been ongoing for about a year and he has been steadily losing weight. He is accompanied by his parents who are deeply worried about their son. After conducting investigations, the following results were obtained:

MRCP2-2144

A 67-year-old man with poorly controlled asthma is admitted to the Respiratory Ward with an exacerbation. He is managed with high-dose IV salbutamol and makes an initially good recovery. There is no other past medical history of note. During his admission, he develops sudden-onset abdominal pain and loose stools, passing up to 2-3 motions per day. There is no vomiting or rectal bleeding.

On examination, his temperature is 38.2°C. He has a heart rate of 100 bpm and a blood pressure of 120/70 mmHg. His abdomen is distended and tender.

Investigations show:
Haemoglobin (Hb) 140 g/L (normal range: 130-170 g/L)
White cell count (WCC) 12.0 x 10^9/L (normal range: 4.0-11.0 x 10^9/L)
Platelets (PLT) 250 x 10^9/L (normal range: 150-400 x 10^9/L)
Sodium (Na+) 137 mmol/L (normal range: 135-145 mmol/L)
Potassium (K+) 3.8 mmol/L (normal range: 3.5-5.0 mmol/L)
Creatinine (Cr) 130 μmol/L (normal range: 50-120 μmol/L)

What is the recommended management for this patient, given the likely diagnosis?

MRCP2-2145

A 35-year-old man returns from a backpacking trip in Cambodia, where he volunteered at a rural clinic. He is concerned about his recent weight loss, constant fatigue, and chronic diarrhea that he describes as large in volume and difficult to flush. Upon examination, he appears thin with a BMI of 18 and has swelling in both ankles. Medical tests reveal the following results:

– Hemoglobin (Hb): 105 g/L (normal range: 130-170 g/L)
– Mean corpuscular volume (MCV): 105 fL (normal range: 80-100 fL)
– White blood cell count (WBC): 5.5 x 10^9/L (normal range: 4-11 x 10^9/L)
– Platelets (PLT): 230 x 10^9/L (normal range: 150-400 x 10^9/L)
– Sodium (Na+): 140 mmol/L (normal range: 135-145 mmol/L)
– Potassium (K+): 4.2 mmol/L (normal range: 3.5-5.0 mmol/L)
– Creatinine (Cr): 95 µmol/L (normal range: 60-110 µmol/L)
– Albumin: 25 g/L (normal range: 35-50 g/L)

A biopsy of his jejunum shows mild villous atrophy, increased crypts and mononuclear cell infiltrates, and lipid accumulation below the basement membrane. Coliform bacteria are also isolated. What is the most likely underlying diagnosis?