MRCP2-1994
A 45-year-old individual complains of epigastric pain that is suspected to be functional gallbladder pain. What symptom sets meet the Rome III diagnostic criteria?
Archives: MRCP Part 2
MRCP2-1970
A 55-year-old woman presents with a 10-month history of fatigue and pruritus. She has a history of rheumatoid arthritis which was diagnosed 3 years ago and has been quiescent. Aside from a flare-up of her rheumatoid arthritis 2 years ago requiring a course of steroids, she has never been on any disease modifying drugs. Her present medications include naproxen 500mg BD and omeprazole 20 mg OD.
During examination, there is evidence of scratch marks and icteric sclera. There is some fullness in the right upper quadrant of her abdomen on palpation.
Her blood tests are:
Hb 110 g/l Na+ 138 mmol/l Bilirubin 60 µmol/l
Platelets 200 * 109/l K+ 4.1 mmol/l ALP 220 u/l
WBC 8.5 * 109/l Urea 2.8 mmol/l ALT 65 u/l
Neuts 6.0 * 109/l Creatinine 80 µmol/l γGT 85 u/l
Lymphs 1.5 * 109/l Albumin 30 g/l
Eosin 0.3 * 109/l
Her antibody screen reveals:
ANA Positive at 1:160 titre
ANCA Negative
AMA Positive at 1:40 titre
ASMA Negative
What medication can be prescribed to alleviate the patient’s pruritus symptoms?
MRCP2-1971
A 38-year-old woman presents to her primary care physician with a 6-month history of fatigue, excessive daytime sleepiness, and generalized itchiness that started approximately 4 months ago. She reports being unable to complete most of her daily tasks. She denies any abdominal pain, fever, or weight loss.
On physical examination, yellowing of the conjunctivae and skin is noted, along with numerous scratch marks over her trunk. Laboratory studies reveal anemia, leukocytosis, thrombocytosis, elevated ESR, elevated bilirubin, elevated ALP, and elevated liver enzymes. Antimitochondrial antibody and antinuclear antibody are positive. Urinalysis and abdominal ultrasound are unremarkable.
What is the most appropriate next step in the management of this patient?
MRCP2-1972
A 45-year-old female presents to the clinic with increasing fatigue and itching. She has been undergoing evaluation at a dermatology clinic for dry skin, which has been present for several years and is now accompanied by this new symptom. Upon examination, the patient appears jaundiced with dry skin and hyperpigmentation over the elbows and knees. All observations are within normal range, and her abdominal exam is unremarkable. The patient’s previous blood test results show abnormal values for haemoglobin, white cell count, platelet count, total bilirubin, ALT, and ALP, with positive results for antinuclear, anti-mitochondrial, and anti-smooth muscle antibodies.
What treatment options are available to slow the progression of the most likely diagnosis for this patient?
MRCP2-1973
A 54-year-old woman presents with several months of widespread itching. She denies any rashes and feels well in herself, aside from feeling more fatigued than usual. She has a past medical history of hypothyroidism, for which she takes levothyroxine.
Examination is unremarkable. Blood tests results are:
Na+ 138 mmol/L (135 – 145)
K+ 4.7 mmol/L (3.5 – 5.0)
Urea 5.6 mmol/L (2.0 – 7.0)
Creatinine 67 µmol/L (55 – 120)
Bilirubin 32 µmol/L (3 – 17)
ALP 178 u/L (30 – 100)
ALT 58 u/L (3 – 40)
γGT 154 u/L (8 – 60)
Albumin 38 g/L (35 – 50)
What is the most appropriate management for this patient’s likely diagnosis?
MRCP2-1974
A 50-year-old woman with rheumatoid arthritis has been on methotrexate for several years and is now experiencing abnormal liver function tests. Which blood test should be ordered to determine the underlying cause?
Bilirubin: 15 µmol/l
ALP: 187 u/l
ALT: 58 u/l
γGT: 98 u/l
Albumin: 32 g/l
MRCP2-1975
A 55-year-old woman presents to the clinic with abnormal liver function test results discovered by her primary care physician. Despite feeling well and being asymptomatic, she has a history of Graves’ hyperthyroidism that was treated with radioiodine and is currently managed with thyroxine. During the examination, the patient exhibits palmar erythema and several spider naevi, but the rest of the examination is unremarkable. Her lab results show a slightly low platelet count, low albumin levels, and elevated bilirubin, alanine aminotransferase, alkaline phosphatase, and gamma gluteryltransferase levels. Smooth muscle antibody is not detected, but anti-mitochondrial antibody is detected. What treatment options are available for this patient?
MRCP2-1976
A 42-year-old woman presents with fatigue and intense itching that has gradually developed over several months and has become unbearable in recent weeks. She has a history of hypertension and was diagnosed with diabetes at the age of 12, both of which have been well controlled lately. Her current medications include Lantus, NovoRapid, lisinopril, and simvastatin. On examination, there is widespread excoriation and some hyperpigmentation, but no signs of fluid overload. Mild splenomegaly is noted on abdominal examination.
Blood tests reveal a hemoglobin level of 106 g/L (normal range: 115-165), mean corpuscular volume of 83 fL (normal range: 80-96), white cell count of 3.1 ×109/L (normal range: 4-11), platelets of 35 ×109/L (normal range: 150-400), ferritin of 15 µg/L (normal range: 15-300), bilirubin of 24 µmol/L (normal range: 1-22), AST of 29 IU/L (normal range: 1-31), ALT of 43 IU/L (normal range: 5-35), alkaline phosphatase of 298 IU/L (normal range: 45-105), sodium of 132 mmol/L (normal range: 137-144), potassium of 5.1 mmol/L (normal range: 3.5-4.9), urea of 8.1 mmol/L (normal range: 2.5-7.5), creatinine of 87 µmol/L (normal range: 60-110), lactate dehydrogenase of 450 IU/L (normal range: 10-250), thyroid stimulating hormone of 4.8 mU/L (normal range: 0.4-5), and thyroxine of 13 pmol/L (normal range: 10-22).
Which diagnostic test is most likely to be helpful in this case?
MRCP2-1977
A 63-year-old woman presents to the clinic with a chief complaint of fatigue lasting for six months. She denies any weight loss, change in bowel habits, cough, or sputum production. She also denies having fevers or sweats. She has occasional joint pains due to rheumatoid arthritis, which was diagnosed three years ago. She works as an assistant in a bookshop and lives with her husband. She has three healthy children and no significant family history. She is a lifelong non-smoker and drinks alcohol infrequently. On examination, she appears well and has xanthelasma around both eyes. Scratch marks are visible on her arms, which she attributes to an allergy to a new washing powder. Her pulse is 70/min with blood pressure 110/65 mmHg. Heart sounds are normal with no murmurs or added sounds. Her chest is clear, and the abdomen is soft and non-tender. The spleen is palpable 3 centimetres below the left costal margin, while the liver and kidneys are not palpable. Neurological examination is normal. What is the most likely diagnosis?
MRCP2-1978
A 55-year-old woman presents with a three month history of pruritus and lethargy. She has a history of hypothyroidism but denies regular alcohol intake. On examination, there is evidence of excoriations and xanthelasma. Her blood results show elevated levels of ALT, AST, ALP, and GGT, with normal bilirubin and INR. An abdominal ultrasound scan is normal with no signs of liver or biliary duct abnormalities. What is the most probable diagnosis for this patient?