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
MRCP2-1965
An 80-year-old man presents to the Emergency department with intermittent abdominal pain, nausea, vomiting, and constipation. He has also experienced a 2-stone weight loss and decreased appetite over the past three months. His medical history includes an anterior resection for colonic cancer three years ago, complicated by an abscess and wound infection. On examination, he appears pale and thin with a distended abdomen. Laboratory investigations reveal a low hemoglobin level, low MCV, and normal electrolyte levels. Arterial blood gas analysis shows a slightly low PCO2 and normal PO2. What is the most likely cause of his symptoms?
MRCP2-1966
A 42-year-old teacher has been experiencing recurring upper abdominal pain, particularly after consuming fatty foods, for the past three years. Despite undergoing an upper gastrointestinal endoscopy and an ultrasound scan of the biliary tree, both of which yielded normal results, the patient’s symptoms persist. A magnetic resonance cholangiopancreatogram (MRCP) was also performed and came back normal, and the patient is currently awaiting an endoscopic retrograde cholangiopancreatogram (ERCP). The patient does not drink alcohol, has a history of anxiety, and takes birth control pills. The patient’s liver function tests are as follows:
Bilirubin 12 μmol/l 2–17 µmol/l
Alanine aminotransferase (ALT) 38 IU/l 5–30 IU/l
Alkaline phosphatase (ALP) 150 IU/l 30–130 IU/l
Amylase 90 U/l < 200 U/l
What is the most probable diagnosis?
MRCP2-1967
A 25-year-old woman presents with a history of intermittent diarrhoea and constipation for the past four years, which has become more problematic since returning from a backpacking trip in Thailand eight months ago. She has no significant medical history except for a family history of hyperthyroidism in her mother. On examination, her body mass index is 18.5 kg/m2, and there are no other specific abnormalities. Laboratory investigations reveal a low haemoglobin level, low MCV, and normal white cell count and platelet count. Her serum electrolytes, urea, creatinine, and thyroid function tests are within normal limits. What is the likely diagnosis?
MRCP2-1968
A 36-year-old man presents to the Gastroenterology clinic with new and concerning symptoms. Eight years ago, he underwent total colectomy due to an acute severe episode of ulcerative colitis that did not respond to intravenous glucocorticoids and biological therapy. Restorative proctocolectomy with ileal pouch-anal anastomosis was performed seven months after colectomy, and the patient had a smooth recovery with minimal gastrointestinal issues in the following years. He has no significant medical history and does not take any regular medications.
However, for the past two months, the patient has experienced an increase in stool frequency (up to 7 times per day), heightened urgency of defecation, and occasional stool seepage overnight. He denies any history of fevers, weight loss, or bloody stool. The patient has not been in contact with anyone with gastrointestinal illnesses and has not traveled recently.
During abdominal examination, the patient’s abdomen was soft and non-tender with active bowel sounds. The patient’s General Practitioner ordered basic investigations, which are listed below.
Stool microscopy, culture, and sensitivity: no organisms seen; no growth
Clostridium difficile toxin: not detected
Haemoglobin 138 g/dL
White cell count 9.9 * 109/L
Neutrophils 7.8 * 109/L
Platelets 336 * 109/L
Urea 5.6 mmol/L
Creatinine 87 micromol/L
Sodium 140 mmol/L
Potassium 5.0 mmol/L
Erythrocyte sedimentation rate 40 ml/h
What is the initial management approach for this patient’s condition?
MRCP2-1969
A 50-year-old male is brought to the ICU due to respiratory failure. He is currently intubated, sedated, and on a ventilator. To facilitate early enteral feeding, a nasogastric tube is inserted. What is the most crucial initial investigation to confirm the correct placement of the tube in the stomach?
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?