Archives: MRCP Part 2

MRCP2-1984

A 47-year-old man with a history of alcoholism has been admitted to the ward for a detoxification program. He was brought to the hospital by police in an intoxicated state. He has been treated with B vitamin replacement therapy and has now begun re-feeding. You are asked to see him because of acute shortness of breath and generalised muscle weakness. On examination his blood pressure is 100/80 mmHg, pulse is 86 beats per minute and regular. He has bilateral crackles on auscultation of his chest consistent with heart failure, and global 4/5 power weakness.

What is the most likely cause of his symptoms?

MRCP2-1985

A 30-year-old female presents with a significant upper gastrointestinal bleed. She has been vomiting frank blood over the past 48 hours. She has a history of chronic back pain and admits to taking ibuprofen over the recommended daily dosage, especially over the past three weeks due to a flare up of her pain.

Upon examination, she appears pale and her abdomen is soft with localised tenderness to the epigastric region. Her blood pressure is 90/60 mmHg and pulse rate is 105 bpm.

Hb 60 g/l
Platelets 65 *109/l
WBC 4.5 *109/l

What is the optimal pre-endoscopy target haemoglobin range for blood transfusion in this patient’s case to achieve the best overall outcome?

MRCP2-1986

You are asked to review a 35-year-old lady on the ward.
She was admitted four days ago following an alcohol related seizure and is currently experiencing some vomiting.
On examination she is emaciated, agitated and confused. Her pulse rate is 96 beats per minute and blood pressure 100/60 mmHg.
Her blood tests reveal:
Haemoglobin 118 g/L (115-165)
White cell count 3.5 ×109/L (4-11)
Mean corpuscular volume 102 fL (80-96)
Platelets 98 ×109/L (150-400)
Sodium 135 mmol/L (137-144)
Potassium 2.1 mmol/L (3.5-4.9)
Urea 3.5 mmol (2.5-7.5)
Creatinine 30 µmol/L (60-110)
Magnesium 0.41 mmol/L (0.75-1.05)
Phosphate 0.4 mmol/L (0.8-1.4)
Plasma glucose 3.5 mmol/L (3.0-6.0)
In addition to correcting the electrolytes what is the most appropriate management plan?

MRCP2-1987

You are requested to assess a 35-year-old woman who has been admitted to the ward for three days due to an alcohol-induced seizure. She is currently experiencing diarrhoea. Upon examination, she appears cachectic, confused, and disoriented. Her pulse rate is 98 beats per minute, and her blood pressure is 102/65 mmHg. Her blood tests reveal low levels of white blood cells, potassium, magnesium, and phosphate. Her haemoglobin levels are slightly low, and her mean corpuscular volume is high. Her plasma glucose levels are also low. What is the most probable diagnosis?

MRCP2-1988

You are on call and the Emergency department refers you a 17-year-old woman who has taken a paracetamol overdose.
The paracetamol level indicates treatment should be carried out and the team in the Emergency department have commenced N-acetylcysteine.
On examination the patient is alert and orientated, there is no asterixis. She has jaundiced sclerae with mild right upper quadrant tenderness.
Which of the following is an indication for referral to a specialist liver unit?

MRCP2-1989

A 26-year-old female presents to the gastroenterology ward with a one-week history of severe bloody diarrhoea and abdominal cramps. On the second day of admission, a flexible sigmoidoscopy is performed, and a diagnosis of ulcerative colitis is made. The patient is started on intravenous steroids and mesalazine enemas, along with intravenous fluid and electrolyte replacement. Low molecular weight heparin and venous thromboembolism prophylaxis are also initiated. A negative pregnancy test is obtained on admission, and the gastroenterology team reviews the patient daily.

On day three of therapy, the patient continues to have at least 10 bowel movements per day. Physical examination reveals a diffusely tender abdomen that is soft to the touch. Laboratory results show:

Hb 92 g/l
Platelets 220 * 109/l
WBC 15.2 * 109/l

Na+ 145 mmol/l
K+ 3.4 mmol/l
Urea 9 mmol/l
Creatinine 150 µmol/l
CRP 121 mg/L

What is the most appropriate next step in management?

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?