Archives: MRCP Part 2

MRCP2-1874

A 72-year-old man is currently admitted to a geriatric medical ward for treatment. He was initially diagnosed with community-acquired pneumonia, despite having no relevant medical history. However, after a week of amoxicillin treatment, he developed an acute kidney injury and severe diarrhoea. The stool sample culture revealed the presence of Clostridium difficile, which he has never had before. Although he has been receiving oral vancomycin for 10 days, he is still experiencing profuse diarrhoea. Despite his stable condition, what is the most appropriate antibiotic treatment for him going forward?

MRCP2-1875

A 67-year-old man on the acute medical unit presents with sudden onset, severe abdominal pain. He is an inpatient being treated for community-acquired pneumonia and has been in persistent atrial fibrillation during this admission. He is not normally on anticoagulants. His bowels have been opening regularly and are of a normal character, and he has not vomited. He has a medical history of type 2 diabetes and gastro-oesophageal reflux disease (GORD).

His vital signs are as follows: oxygen saturations of 95% on 2L oxygen, respiratory rate of 20/min, irregular heart rate at 103/min, blood pressure of 98/62 mmHg, temperature of 37.4ºC, and he remains alert. On abdominal examination, there is a widespread, exquisitely tender abdomen with some guarding and rebound tenderness.

What is the most appropriate next step in managing this patient?

MRCP2-1876

You are requested to assess a 65-year-old female who has recently developed confusion. She has a medical history of alcoholic cirrhosis of the liver. During the examination, you observe that the patient is disoriented to time, place, and person. Additionally, she has asterixis and multiple telangiectasias on her trunk. Based on the likely diagnosis, what is the most suitable medication to recommend?

MRCP2-1877

A 45 year-old man presents to the clinic with a two-day history of severe abdominal pain in the lower left and lower right quadrants, accompanied by diarrhoea, malaise and weight loss. He has a past medical history of Crohn’s disease and has been treated with mycophenolate mofetil for the past 4 months, which is starting to lose its effect. Other treatments for his Crohn’s disease have failed to control his symptoms. He underwent an ileocaecal resection 7 years ago.

Laboratory results show:

– Hb 9.8 g/L
– Platelets 190 * 109/l
– WBC 14.9 * 109/l
– Na+ 135 mmol/l
– K+ 3.8 mmol/l
– Urea 6.8 mmol/l
– Creatinine 90 µmol/l
– CRP 58 mg/l
– ESR 64 mm/hr

The diagnosis is a severe flare-up of his Crohn’s disease. What is the most appropriate next step in management?

MRCP2-1878

A 70-year-old man underwent a routine health check and was found to have microcytic anaemia and a positive faecal immunochemical test (FIT). Further investigations revealed colorectal cancer, and he underwent resection, which showed an adenocarcinoma confined to the mucosa and submucosa. What is his 5-year survival rate based on his Dukes’ stage?

MRCP2-1879

A 35-year-old woman presents to the gastroenterology clinic with a flare of ulcerative colitis. She reports experiencing diarrhoea for the past month, with bowels opening up to 10 times per day. She denies any fevers and has been compliant with mesalazine orally, but has had difficulty administering rectal mesalazine. She is a non-smoker and works as a school teacher, and her symptoms have caused several accidents at work. On clinical assessment, she has moderate diffuse tenderness in her abdomen. Blood tests show low Hb, high platelets and WBC, and elevated ESR. An abdominal X-ray shows bowel wall thickening but no dilatation. A flexible sigmoidoscopy shows moderate inflammation and is terminated due to patient discomfort. She is admitted and treated with intravenous steroids, which improve her symptoms and she is discharged on oral steroids. What interventions should be considered for this patient once she has recovered from her acute flare?

MRCP2-1880

A 16-year-old girl presents to the emergency department 36 hours after taking an overdose of 30 × 500mg paracetamol tablets. She complains of severe nausea, has been vomiting, and now has yellowing of the eyes.

On examination, her blood pressure is 150/80 mmHg, pulse is 90 and regular. She experiences tenderness in the right upper quadrant on abdominal palpation and has significant bruising on her arms and legs.

Investigations reveal the following results:
– Hb 120 g/L (115-160)
– WCC 11.8 ×109/L (4-10)
– PLT 195 ×109/L (130-400)
– Na 139 mmol/L (135-145)
– K 4.8 mmol/L (3.5-5.5)
– Cr 115 µmol/L (70-120)
– Urea 6.8 mmol/L (2.5-8)
– AST 3200 U/L (0-35)
– Bilirubin 60 pmol/L (<26)
– Albumin 34 g/L (35-50)
– Glucose 5.1 mmol/L (>4.5)
– pH 7.32 –
– INR 2.8 –

Based on these findings, which of the following would warrant referral to a specialist liver unit for further management?

MRCP2-1881

A 40-year-old woman presents with increasing itchiness and yellowing of her eyes over the past three weeks. She has a history of primary biliary cirrhosis and Sjogren’s syndrome and is currently taking ursodeoxycholic acid, codeine, and the maximum dose of chlorphenamine with no relief from her pruritus. She works as a singer in a folk band and is on tour across the UK. On examination, she is icteric and has pallor, with numerous erythematous linear scars across her arms and legs. Her blood work shows elevated bilirubin, ALP, ALT, and gamma#GT levels, as well as a positive anti-mitochondrial antibody and anti-smooth muscle antibody. What is the likely cause of her deterioration?

MRCP2-1882

A 22-year-old female comes in with crampy pain in her right iliac fossa and diarrhoea. During colonoscopy, patchy erythema with a cobblestone appearance is observed in her caecum and terminal ileum. She declines prednisolone due to her mother’s past experience with unpleasant side effects. What alternative medication should be suggested?

MRCP2-1883

A patient with Peutz-Jeghers syndrome consults about the risk of their 18-year-old child being born with the condition.

Which of the following patterns of inheritance should you describe?