MRCP2-2112
A 65-year-old man presents with portal hypertension. What would be a possible indication for a transjugular intrahepatic portosystemic shunt?
Archives: MRCP Part 2
MRCP2-2113
A 55-year-old man visited his GP complaining of epigastric discomfort that had been bothering him for two months. He found some relief with antacids. He had no significant medical history and was not taking any regular medication. The GP referred him for an outpatient upper gastrointestinal endoscopy, which revealed moderate duodenitis but no signs of peptic ulceration. The test for Helicobacter pylori was positive, and he was prescribed a seven-day course of omeprazole, amoxicillin, and clarithromycin. When he returned to the clinic four weeks later, he reported being completely symptom-free.
What is the recommended course of action for managing this patient further?
MRCP2-2114
A 28-year-old woman presents with severe abdominal pain, nausea, and vomiting. She has a history of poorly-controlled asthma. Upon questioning, she reports no unusual behavior except for starting a low-carb diet two weeks ago. She has been taking paracetamol and aspirin for her abdominal pain in addition to her regular asthma medication. On examination, she has peritonism and appears to have some proximal muscle weakness. The nurses note that her urine is dark and changes color on standing. Tests reveal elevated urea and urinary ketones. Given the likely diagnosis, what is the most appropriate treatment option?
MRCP2-2115
A 38-year-old woman with a history of ulcerative colitis is admitted to the hospital. She is currently taking azathioprine and receiving iv hydrocortisone. After showing initial improvement on treatment for 3 days, her clinical condition worsens. Biopsies from a flexible sigmoidoscopy reveal evidence of ulcerative colitis as well as a significant number of inclusion bodies. What is the most effective treatment to improve her condition?
MRCP2-2116
A 50-year-old man presents to the Emergency Department with fresh haematemesis. He has a history of alcoholic liver disease and was found to have grade 1 oesophageal varices on endoscopy three years ago. His only medication is thiamine. On examination, he is unwell with a blood pressure of 90/50 mmHg and a heart rate of 120 bpm. Investigations reveal a low haemoglobin level, elevated white cell count, and low platelet count. He is actively resuscitated with fluids and blood products while awaiting urgent upper gastrointestinal endoscopy. During endoscopy, band ligation is performed to control the bleeding, but it is unsuccessful. What is the next best therapeutic option to control this patient’s acute variceal bleed?
MRCP2-2117
A 39-year-old man who is homeless and has a history of alcohol abuse presents at the hospital with gradual abdominal swelling. He reports feeling full quickly and experiencing discomfort due to the distension. Upon examination, his abdomen is significantly distended with shifting dullness. An ascitic tap is performed and the fluid is sent for analysis. Based on the British Society of Gastroenterology guidelines for ascites management, what is the recommended initial treatment for his ascites?
MRCP2-2118
A 60-year-old man has been diagnosed with extensive oesophageal candidiasis. He has a known history of being HIV positive.
What is the recommended treatment for this condition? Should any additional measures be taken?
MRCP2-2119
A 65-year-old man with a long history of diabetes and previous cerebrovascular accident presents with early satiety, postprandial vomiting, and abdominal distension. He is not experiencing haematemesis or abdominal pain and has regular bowel movements. He is overweight, in atrial fibrillation, and has residual right-sided paralysis. On examination, his abdomen is distended and tympanic, but otherwise soft and non-tender with active bowel sounds. Rectal examination reveals soft brown stool. Investigations show abnormal results for haemoglobin, white cell count, platelets, sodium, potassium, creatinine, mean corpuscular volume, international normalized ratio, urea, albumin, corrected calcium, and glucose. Chest X-ray is normal, and abdominal X-ray shows a dilated stomach. Upper GI endoscopy is normal. What is the most appropriate initial therapy? He is currently on insulin therapy, digoxin, and aspirin.
MRCP2-2120
A 35-year-old Turkish software engineer presents to the Emergency Department with a 24 hour history of excruciating abdominal pain, high fever and muscle pain.
During examination, he is found to be febrile with a temperature of 39.5 °C and has diffuse abdominal tenderness with guarding. Bowel sounds are absent. He has a healed surgical scar from a previous hospitalization with similar symptoms. The surgery was inconclusive.
After conducting a plain abdominal X-ray, which showed no abnormalities, the surgical team was consulted and the patient was started on broad-spectrum intravenous antibiotics. His symptoms resolved after 20 hours of admission. He mentioned that his sister had also been hospitalized with similar symptoms in the past.
What medication would you prescribe to improve the long-term outcomes of this condition?
MRCP2-2121
A 68-year-old man presents with severe and persistent dyspepsia, prompting an urgent upper gastrointestinal endoscopy. During the investigation, a thickened area of gastric folds is discovered in the fundus. Biopsies reveal reactive lymphoid follicles with a dense lymphoid infiltrate extending into the submucosa and epithelium, and a positive Campylobacter-like organism test. What is the best course of action for management?