Archives: MRCP Part 2

MRCP2-1928

A 55-year-old male presents with complaints of general lethargy, weight gain, and abdominal swelling. He reports that his symptoms have been worsening over the past three months and admits to heavy alcohol consumption for a long time. He is not currently taking any medication and has no significant medical history.

During examination, he appears well-oriented, has a normal body temperature, and his blood pressure is 132/88 mmHg. He has multiple spider naevi on his upper chest and gynaecomastia. Abdominal examination reveals moderate ascites, and he has edema in his legs up to the mid-thigh. No organomegaly is noted during abdominal examination.

The following investigations were conducted:
– Serum sodium 140 mmol/L (137-144)
– Serum potassium 4.4 mmol/L (3.5-4.9)
– Serum urea 7.8 mmol/L (2.5-7.5)
– Serum creatinine 135 µmol/L (60-110)
– Serum total bilirubin 35 µmol/L (1-22)
– Serum aspartate aminotransferase 70 U/L (1-31)
– Serum alkaline phosphatase 220 U/L (45-105)
– Serum albumin 30 g/L (37-49)

What would be the most appropriate initial management measure for this patient?

MRCP2-1929

A 47-year-old woman is being admitted for therapeutic ERCP to remove multiple large common bile duct stones. She has a medical history of ischemic heart disease and is currently taking aspirin and clopidogrel for secondary prophylaxis. Additionally, she takes simvastatin, lansoprazole, and bisoprolol, and has no known drug allergies. Based on the 2008 BSG guidelines regarding anticoagulant management during endoscopy, what is the best course of action?

MRCP2-1930

A 35-year-old man presents to the Emergency Department with severe epigastric pain, nausea, and vomiting. You note that he was recently started on medication for epilepsy.
Upon examination, his blood pressure is 110/70 mmHg and his heart rate is 100 bpm regular. He has a mild fever of 37.5 °C. The epigastrium is tender, and he experiences significant pain with minimal palpation.
Laboratory results show:
– Haemoglobin (Hb): 130 g/l (normal range: 135-170 g/l)
– White cell count (WCC): 12.5 × 109/l (normal range: 4.0-11.0 × 109/l)
– Platelets (PLT): 150 × 109/l (normal range: 150-400 × 109/l)
– Sodium (Na+): 140 mmol/l (normal range: 135-145 mmol/l)
– Potassium (K+): 4.2 mmol/l (normal range: 3.5-5.0 mmol/l)
– Creatinine (Cr): 135 μmol/l (normal range: 50-120 μmol/l)
– Corrected calcium (Ca2+): 2.25 mmol/l (normal range: 2.2-2.7 mmol/l)
– Amylase: 950 U/l (normal range: 30-110 U/l)

Which of the following medications is most likely responsible for the patient’s symptoms?

MRCP2-1931

A 49-year-old female presents with severe abdominal pain localized at the top of her abdomen that radiates through to her back. She describes the pain as sharp and excruciating. On examination, she has epigastric tenderness but is haemodynamically stable. Her medical history includes ulcerative colitis and osteoarthritis, and she reports taking an oral medication for inflammatory bowel disease and an over-the-counter medication for arthritis, but cannot recall the specific drugs.

The following blood results were obtained:
– Hb: 136 g/l
– Platelets: 582 * 109/l
– WBC: 18.2 * 109/l
– Neuts: 14.2 * 109/l
– Lymphs: 2.2 * 109/l
– Eosin: 0.2 * 109/l
– Na+: 138 mmol/l
– K+: 3.6 mmol/l
– Urea: 8.6 mmol/l
– Creatinine: 62 µmol/l
– CRP: 52 mg/l
– Amylase: 800 U/L (normal < 160) Which medication is most likely responsible for this patient’s presentation?

MRCP2-1932

A 36-year-old patient with locally advanced breast cancer arrives at the Emergency Department 48 hours after receiving her first round of chemotherapy, reporting restlessness and facial grimacing. According to her medical records, her treatment plan was classified as having a moderate risk of causing emesis (30-60%). Which medication is the probable cause of her symptoms?

MRCP2-1910

A 45-year-old woman with no significant medical history presents to the Emergency Department with a 4-hour history of vomiting blood. She reports having gone mushroom foraging five days prior and consuming some of the mushrooms she found. On examination, she appears jaundiced and experiences tenderness in the epigastrium and right upper quadrant of her abdomen. There is evidence of bruising on her arms and legs, as well as dried blood around her lips. Her blood pressure is 110/72 mmHg, heart rate is 92 bpm and regular. The following abnormal laboratory results were obtained: Hb 101 g/l, WCC 10.5 × 109/l, PLT 121 × 109/l, INR 3.6, Na+ 138 mmol/l, K+ 4.2 mmol/l, Cr 255 µmol/l, bilirubin 182 µmol/l, alanine aminotransferase 290 u/l, alkaline phosphatase 99 u/l, and glucose 3.8 mmol/l. What is the next step in managing this patient?

MRCP2-1911

A 45-year-old male presents for an elective ERCP for a common bile duct stone. Post-ERCP he develops acute septicaemia.

Pre-ERCP results:
Serum sodium 136 mmol/L (137-144)
Serum potassium 4 mmol/L (3.5-4.9)
Serum chloride 100 mmol/L (95-107)
Serum bicarbonate 28 mmol/L (20-28)
Serum urea 4 mmol/L (2.5-7.5)
Serum creatinine 96 µmol/L (60-110)

Post-ERCP results:
Serum sodium 140 mmol/L (137-144)
Serum potassium 4 mmol/L (3.5-4.9)
Serum chloride 100 mmol/L (95-107)
Serum bicarbonate 16 mmol/L (20-28)
Serum urea 40 mmol/L (2.5-7.5)
Serum creatinine 720 µmol/L (60-110)

All physical findings are normal and his chest is clinically clear. He is producing 40 ml of urine per hour.

What is the evidence-based recommendation based on recent clinical trials for the management of acute septicaemia in a patient post-ERCP?

MRCP2-1912

A 56 year old man with a history of heavy alcohol consumption presents with hematemesis. What is the most effective treatment approach for esophageal varices during endoscopy?

MRCP2-1913

A 54-year-old man with a six-month history of reflux attends your follow-up Gastroenterology Outpatient Clinic after being referred by his General Practitioner (GP) for a direct access upper gastrointestinal (GI) endoscopy. Despite stopping smoking, reducing and then stopping alcohol consumption, and trying proton pump inhibitors (PPIs) without success with the help of his GP, he has not lost any weight and has a body mass index (BMI) of 33 kg/m2. On examination, his blood pressure is 124/76 mmHg lying down, heart rate is 80 beats per minute and regular, and GI examination is unremarkable. Investigations performed by the GP reveal normal values for haemoglobin (Hb), white cell count (WCC), platelets (PLT), sodium (Na+), potassium (K+), creatinine (Cr), albumin, and alanine aminotransferase (ALT). However, upper GI endoscopy reveals 4 cm of columnar-lined oesophageal epithelium, appearances consistent with Barrett’s oesophagus, and biopsy indicating low-grade dysplasia. What is the most appropriate management regarding the endoscopy findings?

MRCP2-1914

A 35-year-old woman has been diagnosed with hepatitis B surface antigen positivity that has persisted for over six months. Her hepatitis B envelope antigen (HBeAg) is negative, and HBV DNA is also negative. Additionally, all her liver function tests are normal. What would be the most appropriate course of action for further management?