Archives: MRCP Part 2

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?

MRCP2-2023

A 63-year-old patient presents to the acute medical service with sudden onset jaundice. The patient reports occasional wine consumption and a history of recurrent urinary tract infections managed with prophylactic antibiotics. Liver function tests show elevated levels of total bilirubin, unconjugated bilirubin, conjugated bilirubin, ALP, and AST. What is the probable cause of these findings?

MRCP2-2024

A 35-year-old man comes to the clinic with complaints of persistent heartburn and indigestion for the past year. He is worried as his father was diagnosed with oesophageal cancer at a young age. You schedule him for an upper GI endoscopy.
Investigations:

Haemoglobin 140 g/l 130–170 g/l
White cell count (WCC) 6.2 × 109/l 4–11 × 109/l
Platelets 200 × 109/l 150–400 × 109/l
Sodium (Na+) 142 mmol/l 135–145 mmol/l
Potassium (K+) 4.5 mmol/l 3.5–5.0 mmol/l
Creatinine 80 µmol/l 60–110 µmol/l
Endoscopy Helicobacter gastritis
He undergoes successful eradication therapy. What advice would you give him regarding his future risk of cancer and the possibility of needing retreatment for Helicobacter?

MRCP2-2025

A 25-year-old woman presents to gastroenterology clinic with a 6 months history of abdominal bloating and diarrhoea. She is a graduate student and finds that her symptoms are exacerbated by periods of stress. She does not take any regular medications and has no drug allergies. Her aunt was diagnosed with ulcerative colitis at the age of 30 and is currently on biologic therapy for it.

On examination, her temperature is 36.7ºC, blood pressure is 100/50 mmHg and heart rate is 90 beats per minute. Her body mass index is 20.5 kg/m². There were no abnormalities to find on an examination of her cardiovascular, respiratory or abdominal systems.

Her GP had organised some blood tests prior to referring her to clinic:

Hb 130 g/l Na+ 135 mmol/l Bilirubin 12 µmol/l
Platelets 280 * 109/l K+ 4.6 mmol/l ALP 85 u/l
WBC 6.5 * 109/l Urea 3.5 mmol/l ALT 40 u/l
Neuts 4.0 * 109/l Creatinine 50 µmol/l γGT 35 u/l
CRP <1 mg/l Albumin 40 g/l What is the most appropriate next investigation for this patient?

MRCP2-2026

A 60-year-old man visits his GP to inquire about bowel cancer screening after receiving an invitation by mail. What is the most accurate statement about the screening process according to the National Health Service guidelines?

MRCP2-2027

A 24-year-old individual with no prior medical issues presented to the clinic complaining of experiencing diarrhea for the past three weeks, occurring up to ten times per day, including at night. The stools are semi-formed with blood mixed within them. The individual reported experiencing gripping abdominal pain and feeling unwell, but continued to attend classes. Their father had a history of ankylosing spondylitis and uveitis.

During the examination, the individual’s abdomen was soft and non-tender. Rectal examination confirmed bloodstained stool. Although there was no evidence of arthritis, red regions on the shin suggested erythema nodosum. The chest and cardiovascular systems were unremarkable.

What investigation should be conducted first?

MRCP2-2028

A 55-year-old man with known alcoholic hepatitis is admitted to the Emergency Department feeling generally unwell. He has been experiencing vague abdominal pain and general malaise for the past 4 days. His wife reports that he has been eating and drinking much less during this time and confirms that he has been abstinent from alcohol for over a year.

Upon examination, he appears clinically dehydrated and is drowsy. His heart rate is 121 beats per minute and his blood pressure is 102/55 mmHg. His temperature is 37.4 ºC. His chest is clear. His abdomen is soft with suprapubic tenderness but no organomegaly. There is some dullness in the flanks.

His urine dip is positive for nitrites and 1+ leucocytes.

The following are his blood test results:

Hb 115 g/l Na+ 125 mmol/l Bilirubin 24 µmol/l
Platelets 189 * 109/l K+ 4.9 mmol/l ALP 250 u/l
WBC 14 * 109/l Urea 11 mmol/l ALT 124 u/l
Neuts 10 * 109/l Creatinine 230 µmol/l γGT 255 u/l
Lymphs 2.5 * 109/l CRP 75 mg/dl Albumin 30 g/l

He is given antibiotics and normal saline, but after 24 hours, his sodium is 124 mmol/l and creatinine is 229 µmol/l.

His urine sodium is 12 mmol/l, and an ultrasound of the abdomen shows mild ascites, a cirrhotic liver, and a normal renal tract.

What is the most appropriate next step?

MRCP2-2029

A 26-year-old female undergraduate student presented to the gastroenterology clinic with a three-year history of irritable bowel syndrome (IBS) and complaints of constipation. Despite trying dietary advice and various laxatives, including senna and sodium docusate in full doses and a trial of macrogol, there has been no improvement. The patient reports that the issue mainly occurs during exam periods. She had an appendectomy five years ago with no complications. Blood tests revealed:

– Hb: 120 g/L
– Platelets: 310* 10^9/L
– WBC: 8* 10^9/L
– Na+: 140 mmol/L
– K+: 4.4 mmol/L
– Urea: 6.5 mmol/L
– Creatinine: 100 µmol/L

What is the next step in managing this patient’s condition?