Archives: MRCP Part 2

MRCP2-1963

A 23-year-old teacher presented to the clinic with a complaint of chronic diarrhea for the past year. She reported that her stools were difficult to flush away and floated. She denied any weight loss and maintained her appetite. She had traveled to Blackpool eight months ago. Two months ago, a stool culture revealed Giardia lamblia, and she was treated with oral metronidazole for seven days, but her symptoms did not improve. She had no significant medical history and was not taking any regular medication. Her mother had scleroderma. On examination, she appeared thin but well, with no fever or lymphadenopathy. Her chest was clear, heart sounds were normal, and her abdominal examination, including a per rectal examination, was unremarkable. What would be the most appropriate investigation to perform next?

MRCP2-1964

A 28-year-old female presents with a complaint of passing bright red blood per rectum. She has observed blood mixed with stool, mostly in the pan and on the paper. Additionally, she experiences bloating, alternating diarrhoea and constipation with some urgency and tenesmus. This problem has been intermittent for the past five months, and she reports no systemic symptoms. Her weight is stable, and she is currently taking senna and the oral contraceptive pill. What is the probable reason for her rectal bleeding?

MRCP2-1933

A 45-year-old man has been diagnosed with a liver abscess after spending extended periods in South East Asia. The pus drained from the abscess had a rusty brown colour, prompting microbiologic testing for parasites. The results revealed that the causative agent was Entamoeba histolytica. What is the most suitable medication for this condition?

MRCP2-1934

You review a 57-year-old man in gastroenterology clinic who has had 3 months of diarrhoea and weight loss. He complains of going to the toilet up to 7-8 times a day and has lost 1 stone in weight over this 3 month period. He denies any blood or mucous in his stools. His past medical history includes hypertension and type 2 diabetes. His drug history includes metformin and lisinopril.

Examination of the abdomen reveals mild diffuse tenderness but with no guarding or rigidity and no mass palpable.

Investigations have been undertaken revealing the following:

Hb 120 g/L Male: (130 – 180)
Platelets 400 * 109/L (150 – 400)
WBC 9.8 * 109/L (4.0 – 11.0)
Na+ 138 mmol/L (135 – 145)
K+ 3.8 mmol/L (3.5 – 5.0)
Urea 6.2 mmol/L (2.0 – 7.0)
Creatinine 98 µmol/L (55 – 120)
CRP 28 mg/L (< 5) Colonoscopy Good views of the large bowel up to the normal appearance of the large colon, no polyps identified, no cause for symptoms. Biopsies were taken and sent for histology Histology Lymphocytic infiltrate within the intestinal villi. What is the most important management step in view of the likely underlying condition?

MRCP2-1935

A 26-year-old man, who is typically healthy, comes in with a 2-week history of crampy abdominal pain and bloody diarrhoea. During a colonoscopy, erythema and oedema are observed in the distal colon, along with signs of proctitis. Before starting mesalazine, what blood test(s) should be conducted?

MRCP2-1936

A 45-year-old man has been experiencing chronic abdominal pain for the past three years. His pain is alleviated by defecation and he has noticed an increase in stool frequency. The symptoms seem to worsen during times of stress. Based on this information, what symptoms suggest a diagnosis of irritable bowel syndrome?

MRCP2-1937

A 45-year-old female patient presents with excessive diarrhoea and reports experiencing flushing, especially after consuming red wine. During examination, a pansystolic murmur is detected over the praecordium, with the loudest sound heard at the lower left sternal edge. What compound excess is the probable cause of her diarrhoea?

MRCP2-1938

A 20-year-old male is brought into the Emergency Department by police with facial injuries following an altercation with a work colleague. They are accompanied by his tearful mother, who reports that her son has developed violent mood swings and become increasingly aggressive over the last 6 months. There is no relevant past medical history.

On examination, the patient is mildly dysarthric and tearful but denies drinking alcohol. His observations are normal and examination of the precordium is unremarkable. His abdomen is soft and non-tender. Peripheral neurological examination reveals the presence of mildly increased tone, although there is no weakness. A ‘wing-beating tremor’ is also observed.

Blood tests are as follows:

Hb 132 g/l Na+ 143 mmol/l Bilirubin 23 µmol/l
Platelets 189* 109/l K+ 4.2 mmol/l ALP 189 u/l
WBC 7.6* 109/l Urea 4.1 mmol/l ALT 342 u/l
Neuts 5.3* 109/l Creatinine 76 µmol/l γGT 122 u/l
Lymphs 2.1* 109/l Albumin 43 g/l
Eosin 0.3* 109/l

What investigation should be performed next based on the likely diagnosis?

MRCP2-1939

A 58-year-old man presents to the medical assessment unit with complaints of epigastric pain and discomfort. The symptoms have been present for the last two months and are worse at night and when lying down. He reports taking lansoprazole 30 mg once daily and Gaviscon as required for the last four weeks, but has not found relief. There is no history of dysphagia or unintentional weight loss. On examination, there are no notable findings.

Based on NICE guidelines for the management of dyspepsia, what is the most appropriate course of action for this patient?

MRCP2-1940

A 56-year-old man presents to the emergency department with abnormal liver function tests discovered by his primary care physician. He has no significant medical history other than type 2 diabetes mellitus. He reports consuming approximately 18 units of alcohol per week. On examination, there are no signs of respiratory distress, he is warm and well perfused, and tenderness is noted in the right upper quadrant. However, his abdomen is soft and non-tender. He has mild jaundice in the sclera, and his body mass index is 30kg/m².

Initial investigations reveal:

– Bilirubin 22 µmol/L (3 – 17)
– ALP 118 u/L (30 – 100)
– ALT 360 u/L (3 – 40)
– AST 132 u/L (3 – 40)
– γGT 68 u/L (8 – 60)
– Albumin 38 g/L (35 – 50)

HBsAg negative
Anti-HBs positive
Anti-HBc negative
Anti-HCV negative

An abdominal ultrasound shows multiple gallstones in the gallbladder with no biliary tree dilation.

What is the most probable diagnosis?