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?

MRCP2-1901

A 45-year-old woman presents with abnormal liver function tests discovered incidentally. She denies any history of excessive alcohol consumption and has no prior medical conditions. There is no family history of liver disease. On physical examination, there are no signs of chronic liver disease, but her liver is palpable 3 cm below the right costal margin. Her blood work reveals a hemoglobin level of 130 g/L (130-180), MCV of 94 fL (80-96), WBC of 5 ×109/L (4-11), platelets of 200 ×109/L (150-400), CRP of 10 mg/L (<10), bilirubin of 15 µmol/L (1-22), ALT of 310 U/L (5-35), ALP of 130 U/L (45-105), AST of 260 U/L (1-31), and GGT of 100 U/L (4-35). Her albumin level is 37 g/L (37-49). An abdominal ultrasound scan shows an enlarged liver with diffusely increased and heterogeneous echogenicity. What is the likely diagnosis?

MRCP2-1902

You review a 40-year-old man in the gastroenterology clinic who has been referred by his GP with abnormal liver function tests. The only past medical history is a recent diagnosis of hypertension.

On direct questioning, he denies alcohol intake or intravenous drug use. There is no travel history.

On examination, he is pale, there is evidence of finger clubbing and he has spider naevi over the anterior chest wall. Abdominal examination reveals tender hepatomegaly 3 cm below the costal margin.

What is the most likely diagnosis?

MRCP2-1903

A 46-year-old man presents with abnormal liver function tests and denies regular alcohol intake. Upon examination, he appears confused but does not exhibit asterixis. A 3 cm hepatomegaly is noted during abdominal examination. Which blood result is indicative of alcoholic liver disease?

MRCP2-1904

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 liver enzymes and bilirubin levels, but an abdominal ultrasound scan is normal. If this woman were to undergo a liver transplant for her underlying condition, what would be her five-year survival rate?

MRCP2-1905

A 45-year-old individual complains of perianal itching, tenesmus, and bloody discharge. During the clinic examination, the doctor observes firm bilateral inguinal lymphadenopathy. What is the most probable diagnosis?