Archives: MRCP Part 2

MRCP2-2013

A 57-year-old man comes to the emergency department complaining of worsening shortness of breath. He has a medical history of oesophageal cancer, which was treated six months ago with an oesophagectomy and postoperative chemotherapy and radiotherapy. He has been in remission for three months. Over the past week, his shortness of breath has gotten worse and has been accompanied by abdominal distension. Upon examination, there is dullness to percussion of both lung bases with reduced air entry. His abdomen is tense with shifting dullness, but not very tender. His skin is warm and well perfused. There is no swelling in his legs, and there is no tenderness or pitting oedema. A chest X-ray shows small bilateral pleural effusions. What is the most appropriate treatment to alleviate his shortness of breath?

MRCP2-2014

A different patient is diagnosed with cholangiocarcinoma. They have a staging CT which states that the tumour involves both the confluence of the right and left hepatic ducts with tumour involvement in both ducts. According to the Bismuth-Corlette classification, what type of cholangiocarcinoma is this?

MRCP2-2015

A 40-year-old woman presents to hepatology with jaundice and abnormal liver function tests. She has no medical history and does not smoke or drink alcohol. On examination, there is mild ascites and scleral icterus. Her BMI is 24 kg/m². Blood tests reveal elevated bilirubin, ALP, and ALT levels. Further investigations show positive antinuclear and anti-smooth muscle antibodies, but negative results for hepatitis B and C, HIV, and other autoimmune markers. What is the most likely diagnosis?

MRCP2-2016

A 70-year-old man with a history of Barrett’s oesophagus presents to gastroenterology clinic for routine follow-up. He was referred by his GP 2 months ago due to long-standing symptoms of gastro-oesophageal reflux. An initial endoscopy revealed a minor hiatus hernia and a 5 cm length of circumferential salmon-coloured epithelium extending above the gastro-oesophageal junction, with mild oesophagitis elsewhere. Biopsies taken during the procedure showed flat intestinal metaplasia with mild dysplasia present in 4 of 8 samples, but no high-grade dysplasia or adenocarcinoma.

The patient underwent successful endoscopic radiofrequency ablation and reported only mild chest pain during the first few days of recovery. He has a past medical history of hypertension and osteoarthritis of both knees, and takes paracetamol, omeprazole, ramipril, and bendroflumethiazide. He reported a previous adverse reaction to penicillin but could not recall the details of the event. There is no family history of Barrett’s oesophagus or oesophageal adenocarcinoma, and he has never smoked but consumes 20 units of alcohol per week.

What is the appropriate schedule for follow-up surveillance endoscopy after successful endoscopic therapy?

MRCP2-2017

A 35-year-old woman has been diagnosed with irritable bowel syndrome (IBS). She has previously visited the gastroenterology clinic and all tests, including colonoscopy, were normal. Her main concerns are abdominal pain, bloating, and constipation. Despite taking antispasmodics, regular Movicol (macrogol laxative), and receiving advice from a dietician, she still experiences symptoms. She has previously tried other laxatives with limited success. What would be the most suitable next step?

MRCP2-2018

A 65-year-old man presents to your clinic with persistent symptoms of reflux. He recently underwent an endoscopy to investigate the issue. The results of the gastroscopy show a 3cm pink mucosa arising from the gastroesophageal junction in the oesophagus, patchy antral erythema in the stomach, and a normal duodenum. A biopsy was taken from the oesophagus, and the histology report shows squamous epithelium and squamocolumnar junctional mucosal with reflux oesophagitis, some goblet cells, and low-grade dysplasia in the basal portions of the crypts.

What is the recommended management option for this diagnosis?

MRCP2-2019

A 28-year-old man presents with a 6-month history of chronic diarrhoea and occasional rectal bleeding. He works as a bartender and smokes a pack of cigarettes per day. His father has a history of Crohn’s disease. Blood tests reveal microcytic anaemia and an elevated C-reactive protein level. During colonoscopy, inflammation is observed in the ileum and ascending colon, with a normal rectum. Histology results are inconclusive. The patient is eager to know the specific diagnosis. What findings would support a diagnosis of Crohn’s disease?

MRCP2-2020

A 45-year-old female with a recent diagnosis of type 2 diabetes mellitus presents with fatigue. She has a history of obesity and high cholesterol levels. She does not smoke and only drinks alcohol on special occasions. Her sister has Graves’ disease. During the examination, a soft yellow plaque is noted on her eyelids bilaterally.

The following tests were conducted:

– Hb: 13 g/dl
– Platelets: 175 * 10^9/l
– WBC: 5 * 10^9/l
– MCV: 80 fl
– MCH: 0.4 fmol/cell
– MCHC: 20 mmol/l
– Na+: 135 mmol/l
– K+: 4 mmol/l
– Creatinine: 80 µmol/l
– Urea: 3 mmol/l
– ESR: 40 mm/hr
– Alkaline phosphatase: 300 IU/l
– Gamma glutamyl transpeptidase: 100 IU/l
– Alanine transaminase: 60 IU/l
– Aspartate transaminase: 15 IU/l
– Bilirubin: 10 µmol/l
– Serum albumin: 40 g/l
– Serum cholesterol: 7 mmol/l

What additional investigation would be most useful in reaching a diagnosis?

MRCP2-2021

A 42-year-old woman presents to the follow-up clinic 8 weeks after a small bowel resection for Crohn’s disease. She is currently taking azathioprine and a tapering dose of corticosteroids. She smokes 10 cigarettes per day and tries to maintain a normal diet. On physical examination, her blood pressure is 115/78 mmHg, pulse is regular at 70 beats per minute. There are no significant findings in her cardiac and respiratory systems. Her abdomen is soft and non-tender, with a midline scar consistent with the recent laparotomy. Her body mass index is 22 kg/m². Routine blood tests are normal.

What is the most important factor in reducing the risk of future exacerbations?

MRCP2-2022

A 23-year-old male patient complains of a tremor and a sensation of decreased speed. He has been experiencing more frequent nausea and abdominal pain, particularly in the right upper quadrant. Additionally, his friends have noticed a change in the color of his eyes, which are becoming yellow.

What investigation finding would be most indicative of a Wilson’s disease diagnosis?