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?
Archives: MRCP Part 2
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?
MRCP2-1990
You are requested to assess a 19-year-old female patient who is receiving IV N-acetylcysteine for a paracetamol overdose. During the infusion, after 20 minutes, she experiences facial flushing, intense itching, and a 12 mmHg drop in blood pressure. The infusion has been discontinued, and the FY1 has administered IV antihistamine. What is the most suitable course of action to take next?
MRCP2-1991
A 60-year-old man with worsening jaundice is referred by his GP. He has a history of occasional alcohol consumption and spent many years working for an oil company in the Far East and Africa. He also has mild hypertension but no other significant medical history. Upon examination, he displays signs of advanced cirrhosis. The hepatic ultrasound suggests the presence of a hepatocellular carcinoma, and his alpha-fetoprotein levels are elevated. What factor would you link to hepatocellular carcinoma in this patient?
MRCP2-1992
A patient is diagnosed with cholangiocarcinoma. What is the most common predisposing factor for the development of this condition?
MRCP2-1993
A 45-year-old individual complains of functional constipation. What symptom sets meet the Rome III diagnostic criteria?