Archives: MRCP Part 2

MRCP2-1995

You assess a 20-year-old male patient at the gastroenterology clinic who has a known history of hepatitis B. He has recently relocated to the UK from India. What is the predominant mode of hepatitis B transmission globally?

MRCP2-1996

A 38-year-old man of Middle Eastern descent presents to the hospital with haematemesis and haematuria. During an upper gastrointestinal endoscopy, it is discovered that oesophageal varices are the cause of the bleeding. Upon examination, the liver is palpable 3 cm below the costal margin and the spleen can be felt 2 cm below the costal margin. The patient’s blood tests show a low haemoglobin level, low platelet count, and elevated bilirubin and ALP levels. A liver biopsy reveals granulomas and fibrosis. Based on these findings, what is the most likely cause of the patient’s liver disease?

MRCP2-1997

A 55-year-old man presents to the emergency department with abdominal pain. He has no past medical history and does not take any regular medications. He works as a cattle farmer in rural Scotland. He drinks 1-2 bottles of whiskey a week.

His vital signs are as follows:

Heart rate 90 beats per minute
Blood pressure 118/70 mmHg
Respiratory rate 16/minute
Oxygen saturations 97% on room air
Temperature 37.6C

During examination, he experiences tenderness in the right upper quadrant and there is evidence of hepatomegaly.

Blood tests reveal:

Hb 140 g/L Male: (135-180)
Female: (115 – 160)
Platelets 192 * 109/L (150 – 400)
WBC 11.8 * 109/L (4.0 – 11.0)
Na+ 139 mmol/L (135 – 145)
K+ 4.1 mmol/L (3.5 – 5.0)
Urea 5.5 mmol/L (2.0 – 7.0)
Creatinine 92 µmol/L (55 – 120)
Bilirubin 11 µmol/L (3 – 17)
ALP 87 u/L (30 – 100)
ALT 42 u/L (3 – 40)
γGT 62 u/L (8 – 60)
Albumin 35 g/L (35 – 50)
CRP 20 mg/L (<4) A CT scan of the abdomen is ordered, which reveals a large cystic lesion with a calcified laminar wall, floating inclusions, and three peripheral daughter cysts. What diagnostic test is most likely to confirm the diagnosis?

MRCP2-1998

A 65-year-old woman complains of fatigue. She has been postmenopausal for three years and has no known medical conditions. Her blood test reveals a haemoglobin level of 103 g/L and a C-reactive protein level of <5 mg/dL. Based on the British Society of Gastroenterology recommendations for managing iron deficiency anaemia, what is the most sensitive indicator of iron deficiency?

MRCP2-1999

A 40-year-old man reports experiencing burning abdominal discomfort for the past six months. His GP has referred him to the gastroenterology clinic due to the persistence of his symptoms.

What sign or symptom would indicate the need for an endoscopy?

MRCP2-2000

A 42-year-old woman presents to the gastroenterology clinic with a 6-month history of weight loss, fatigue, and diarrhoea. She has a history of scleroderma for the past 12 years but has not taken any medications for it. Her symptoms are not exacerbated by any particular foods, and she maintains a varied diet. During examination, skin bruising and a peripheral neuropathy in a glove-and-stocking distribution were noted.

The following investigations were conducted:
– Hb: 108g/l (115-165)
– MCV: 103fl (80-96)
– WBC: 10.2 * 109/l (4.0-11.0)
– Serum vit B12: 140 ng/l (160-760)
– Serum folate: 10.5µg/l (2.0-11.0)
– CRP: 130 mg/l (<10)
– Anti TTG antibodies: negative

What would be the most appropriate initial investigation to establish a diagnosis?

MRCP2-1980

You evaluate a 35-year-old man at the Dermatology Clinic who presents with unsightly pustules on his shin that have formed an ulcerated patch and appear blue-black. His General Practitioner suspects a spreading bacterial infection. The patient has a history of diarrhoea but no other significant medical history. Blood tests show elevated viscosity, C-reactive protein, and alkaline phosphatase. A biopsy of the ulcer edge reveals vasculitis and an intense neutrophilic infiltrate. What is the most probable underlying cause of this patient’s skin changes and symptoms?

MRCP2-1981

A 54-year-old man presents to the emergency department with right upper quadrant pain and fever. He has a past medical history of type 2 diabetes and takes regular metformin.

Observations:

Heart rate 101 beats per minute
Blood pressure 101/54 mmHg
Respiratory rate 20/minute
Oxygen saturations 95% on room air
Temperature 38.4C

On examination, there is tenderness without guarding in the right upper quadrant.

A CT abdomen with contrast is arranged, which demonstrates a central low attenuation lesion surrounded by a high attenuation inner rim and a low attenuation outer ring.

What is the appropriate management for this likely diagnosis?

MRCP2-1982

A 12-year-old boy is referred to the hospital for investigation of his short stature. He has had intermittent episodes of stomach pain and diarrhea over the past year, which have resolved on their own. His family doctor has previously diagnosed him with a stomach bug. He also complains of recent hip pain that is affecting his ability to walk, and he has missed school a few times.
He takes occasional acetaminophen and does not smoke. His grandfather is being monitored for colon polyps.
During the examination, he appears pale. There is no swelling of the lymph nodes. He has tenderness throughout his abdomen, but there is no enlargement of any organs.
The following are the results of the investigations:

Haemoglobin (Hb) 88 g/l 115–155 g/l
White cell count (WCC) 3.5 × 109/l 4.0–11.0 × 109/l
Platelets (PLT) 75 × 109/l 150–400 × 109/l
Mean corpuscular volume (MCV) 112 fl 76–98 fl
Erythrocyte sedimentation rate (ESR) 80 mm/hour 1–20 mm/hour
Biochemistry is normal. He subsequently underwent a barium follow-through and a bone marrow aspirate, which shows a megaloblastic picture.
The radiologist noted the presence of the ‘Kantor’s string sign’ on the barium meal and follow-through.
What is the most probable diagnosis?

MRCP2-1983

A 59 year-old woman presents to hospital after 2 episodes of vomiting up blood. It began 2 hours prior to presenting at hospital and the patient was at home at the time. She has a past history of a duodenal ulcer and also suffers from irritable bowel syndrome, hypertension and hypercholesterolaemia. Her regular medication includes simvastatin and ramipril. She is admitted under the gastroenterology team and undergoes fluid resuscitation and successful sclerotherapy. The next morning, the patient vomits up a moderate amount of blood.

What is the most appropriate management?