Archives: MRCP Part 2

MRCP2-4780

A 56-year-old man presents with a history of malaise and fever for several months. He complains of intermittent swelling and pain in his left ear, painful red eyes, and arthralgia. He has no past medical history and is not taking any regular medications.

During the examination, you observe left auricular swelling, bilateral anterior uveitis, and symmetrical small joint polyarthritis.

Lab results show Hb 115 g/l, Na+ 138 mmol/l, platelets 330 * 109/l, K+ 4.2 mmol/l, WBC 13.1 * 109/l, urea 6.2 mmol/l, neuts 10.4 * 109/l, creatinine 95 µmol/l, lymphs 2.5 * 109/l, CRP 132 mg/l, eosin 0.6 * 109/l, pANCA negative, C3 normal, C4 normal, ANA negative, Anti Sm negative, RhF positive, and Anti CCP negative.

What is the most likely diagnosis?

MRCP2-4781

A 60-year-old Asian woman presents to the Rheumatology Clinic with chronic joint issues. She reports initial involvement of the small joints in her hands, which resolved after a few weeks, but now her wrists, elbows, and knees are primarily affected. She has a history of recurrent ear infections and nasal septum inflammation, for which she received antibiotics and pain relief. Her family has a history of systemic lupus erythematosus, and she takes amlodipine for hypertension. On examination, her wrists and knees are swollen and tender with limited movement, and her nose is saddle-shaped with red and tender right upper ear cartilage. Lab results show low hemoglobin, high white cell count and erythrocyte sedimentation rate, and slightly elevated creatinine. Rheumatoid factor and antinuclear antibody tests are negative, and urine dipstick is normal. What is the most probable diagnosis?

MRCP2-4782

A 35-year-old female patient visits her primary care physician, reporting symptoms of dry eyes, dry mouth, and discomfort during sexual intercourse due to vaginal dryness. The patient has no notable medical history, including no history of rheumatoid arthritis or connective tissue disorders. What is a possible clinical manifestation in this scenario?

MRCP2-4783

A 54-year-old woman comes to the clinic complaining of fatigue and dry eyes that have been bothering her for a few months. She also reports having a significantly dry mouth, which sometimes makes it difficult for her to eat. She has no notable medical history.

During the examination, the doctor observes mild redness in the eyes and a dry tongue. Suspecting a particular diagnosis, the doctor orders an initial blood test:

Antinuclear antibodies 1:1600 (<1:280) What is the most conclusive test to confirm the suspected diagnosis?

MRCP2-4753

A 67-year-old woman is urgently admitted to the hospital due to an abnormality found in her routine blood tests. She has a history of rheumatoid arthritis and is currently taking methotrexate, folic acid, ramipril, atorvastatin, and antibiotics for a urinary tract infection. Her blood results show a hemoglobin level of 68 g/l, platelets of 65 * 109/l, WBC of 2.1 * 109/l, neutrophils of 0.5 * 109/l, lymphocytes of 0.7 * 109l, and monocytes of 0.1 * 109l. Which antibiotic prescribed for this patient could be responsible for this presentation?

MRCP2-4754

A 40-year-old lady with diffuse systemic sclerosis presents to the rheumatology clinic with worsening arthralgia in her hands and feet. She denies any other symptoms. On examination, she has sclerodactyly and tender small joints with mild swelling. Her blood pressure is 161/94 mmHg, heart rate is 90 beats per minute, and oxygen saturations are 96% on room air. Her blood tests reveal anemia, elevated ESR, and low albumin levels. Which medication should be used cautiously in this patient?

MRCP2-4758

A 36-year-old male electrician is referred to the medical assessment unit by his GP due to reduced oxygen saturations. He has had mild asthma since childhood but no other medical history of note. His medications are a salbutamol inhaler when required and co-codamol for long standing back pain. On examination he is found to have an early diastolic murmur but no other abnormalities are detected. He goes on to have a chest x-ray which demonstrates apical interstitial shadowing. He undergoes pulmonary function tests which are as follows:

FEV1 1.9L (Predicted 2.1-3.1)
FVC 2.2 (Predicted 3.0-4.4)
TLC 4.5 (Predicted 5.0-7.5)
Transfer factor (DLCO) Low

What is the most likely diagnosis?

MRCP2-4759

As the medical doctor in charge of an acute medical admissions unit, you receive a 55-year old female patient with a history of hypertension, pulmonary fibrosis, and recent diagnosis of Raynaud’s phenomenon. She complains of feeling generally unwell and reports experiencing dysphagia for the past few months, which is currently being investigated by the gastroenterology team at your hospital. The patient is currently taking amlodipine 5mg od.

Upon assessment, her vital signs are as follows: temperature 36.4°C, pulse 88/min, blood pressure 172/88 mmHg, respiratory rate 14/min, and sats 100% on room air. Her chest is clear, and her abdomen is soft and non-tender. Blood tests reveal an acute kidney injury with the following results: sodium 141 mmol/l, potassium 4.6 mmol/l, urea 27 mmol/l, creatinine 320 µmol/l (her GP notes state she had a normal renal function from a routine blood test 1 month ago).

What is the most appropriate course of treatment for this patient at this stage?

MRCP2-4760

A 26-year-old woman presents to her GP with a persistent cough for the past 4 days. She has been experiencing knee pain and has started taking ibuprofen and undergoing physiotherapy for her knee. While recovering, she began exercising at the gym and noticed that she felt breathless and had tightness in her chest. This was followed by a non-productive cough that is worse at night. She sleeps with two pillows and denies any ankle swelling. She has a history of childhood breathing problems for which she took inhalers, but these have since resolved. She admits to smoking 20 cigarettes a day for the past decade and takes no regular medication. She has not traveled abroad or had any contact with sick individuals.

Upon examination, she has a dry cough and is able to speak in full sentences. She has a clear chest with mild wheezing heard in the left lower base. Her peak flow is 220, and she saturates at 98% in air with a respiratory rate of 21 breaths per minute.

Sodium: 139 mmol/l
Potassium: 4.2 mmol/l
Urea: 5.1 mmol/l
Creatinine: 68 µmol/l

Hemoglobin: 110 g/l
Platelets: 390 * 109/l
White blood cells: 10.0 * 109/l

Chest x-ray shows clear lung fields with good chest expansion and no active lung lesion.

What is the probable diagnosis?

MRCP2-4761

A 67-year-old man presents to the hospital with acute pain in his left hip after a fall. His medical history includes Paget’s disease and depression, for which he takes venlafaxine. As a child, he was treated for acute lymphocytic leukaemia. The orthopaedic team has requested advice as the CT scan shows demineralisation in the femur and pelvis. A DEXA scan confirms osteoporosis. Blood tests reveal a calcium level of 2.0 mmol/L (2.1-2.6), phosphate level of 0.9 mmol/L (0.8-1.4), magnesium level of 0.9 mmol/L (0.7-1.0), TSH level of 8.9 mU/L (0.5-5.5), free T4 level of 3 pmol/L (9.0 – 18), free testosterone level of 82 ng/dL (in ages >50 years: 193 – 740), and ALP level of 202 U/L (60-306). What factors in this man’s medical history and blood tests could contribute to his development of osteoporosis?