Archives: MRCP Part 2

MRCP2-1790

A 24-year-old man presented with a 4-week history of offensive-smelling, pale diarrhoea and abdominal cramps. He had recently returned from travelling in South America, New Zealand and Nepal, where he had two episodes of diarrhoea or vomiting which had self-resolved.

On examination, he had mild tenderness in the abdomen and soft brown stool on rectal examination. He was given a single dose of 2 g of tinidazole empirically, but two weeks later he presented with ongoing diarrhoea and was referred for further investigation. Investigations revealed duodenal villous atrophy and normal colonoscopy. Stool culture and microscopy showed no growth or parasites.

What is the most likely diagnosis?

MRCP2-1791

A 75-year-old Asian man who has recently arrived in the UK presents with a two-month history of weight loss, loss of appetite, a dull ache in the right upper abdomen, and abdominal swelling. He does not smoke or drink alcohol. During the examination, an enlarged, tender, and irregular liver is palpable, and ascites is evident. His viral screen is negative, and his liver function tests are elevated. What is the probable diagnosis in this scenario?

MRCP2-1792

A 68-year-old woman presents with complaints of worsening abdominal pain and bloody diarrhoea for the past two weeks. She reports that her abdominal discomfort worsens after eating. Her medical history includes hypertension and angina, and she is currently taking aspirin, simvastatin, and bisoprolol. She has also been taking ibuprofen for joint and abdominal pain. On examination, her pulse is irregular at 102 bpm, blood pressure is 112/54 mmHg, and there is mild tenderness in the left iliac fossa. A flexible sigmoidoscopy reveals ulceration of the mucosa involving the descending colon to the splenic flexure with rectal sparing and several diverticula. What is the most likely cause of her symptoms?

MRCP2-1793

A 16-year-old boy presents to the Emergency Department with complaints of fever, abdominal pain and vomiting for the past three days. On examination, his blood pressure is 120/70 mmHg and his heart rate is 96 bpm. His temperature is 38.5 °C. Abdominal examination reveals tenderness in the left iliac fossa.

The patient is taken up for a laparoscopic surgery. Intraoperatively, the colon is noted to be normal and the area surrounding the colon, including the sigmoid colon and mesenteric nodes, is found to be inflamed.

What is the most likely diagnosis in this patient?

MRCP2-1794

A 35-year-old man presents with occasional episodes of constipation, diarrhoea, abdominal bloating and excessive gas. He has not experienced any significant weight loss in the past year. On clinical examination, there are no notable findings. His blood pressure is 120/80 mmHg, pulse is 70/min and regular, BMI is 23 and his abdomen is soft and non-tender. Faecal occult blood tests are negative and his haematological and biochemical investigations are normal. What is the most likely diagnosis based on these symptoms?

MRCP2-1795

A 46-year-old man presents to the clinic with a 3-month history of chronic epigastric discomfort that radiates to his back and right shoulder tip. He experiences nausea and foul-smelling stools, and has lost 2 stones in weight. He drinks a bottle of wine most nights and smokes 20 cigarettes/day. On examination, he appears neglected, has a tender abdomen, and decreased sensation to light touch on both feet. His investigations reveal low Hb, high WCC and PLT, elevated ALT and ALP, and mildly enlarged liver with fatty change. His secretin test shows a volume collected of 110 ml and a bicarbonate level of 52 mEq/l. What is the most likely diagnosis?

MRCP2-1796

A 63-year-old woman presents with severe abdominal pain and worsening bloody diarrhoea. She reports experiencing intermittent bloody diarrhoea for the past two months, which has recently increased in frequency to six times per day, along with left-sided abdominal pain. She has a medical history of hypertension and angina and is currently taking aspirin, simvastatin, and bisoprolol. Additionally, she has been taking ibuprofen for abdominal and joint pain. During examination, she has an irregular pulse of 102 bpm, blood pressure of 112/54 mmHg, and a temperature of 37.9°C. Mild tenderness is present in the left iliac fossa. A flexible sigmoidoscopy reveals mucosal ulceration involving the left side of the colon to the splenic flexure. What is the most likely cause of her symptoms?

MRCP2-1797

A 32-year-old woman presents with a 4-week history of frequent, watery diarrhoea. She has lost 10 pounds in weight during this time, despite having a good appetite. She denies any blood or mucous in her stool and has no abdominal pain, distension, or vomiting. She reports feeling tired but has no other symptoms. She has no significant medical history, takes no regular medications, does not smoke, and drinks alcohol occasionally. There is no relevant family history. She has not traveled outside of the country recently. On examination, she appears thin but not wasted, with no lymphadenopathy, jaundice, or clubbing. Her abdomen is soft and non-tender without masses, and normal bowel sounds. Digital rectal examination is normal. Laboratory investigations reveal a haemoglobin level of 110 g/l (normal range 120-160 g/l), a white cell count of 3.2 × 109/l (normal range 4.0-11.0 × 109/l), and a platelet count of 250 × 109/l (normal range 150-400 × 109/l). What would be the most appropriate next step in investigating the cause of her diarrhoea?

MRCP2-1798

A 40-year-old man returns from a significant period abroad working for a tech company in Japan. He reports chronic diarrhoea over the past few months with associated weight loss, fatigue, and now lower limb oedema. Upon examination, he appears pale and has stomatitis and glossitis. His BMI is only 21 and he admits to having lost 5 kg in weight in 2 months. Further investigations reveal megaloblastic anaemia, low albumin levels, positive D-xylose malabsorption test, and elevated faecal fat excretion. Anti-endomysial antibodies are negative. What is the most likely diagnosis for this patient?

MRCP2-1799

A 43-year-old woman with a history of small bowel diverticulae and anaemia presents with pins and needles in her hands and feet, weight loss, and offensive-smelling stool. She is a non-smoker and non-drinker who eats red meat. On examination, she has normal leg power and tone, exaggerated knee jerks, absent ankle jerks, absent joint position and vibration sense below her ankles, and extensor plantar responses. Her blood tests show macrocytosis, hypersegmented neutrophils, low haemoglobin, high bilirubin, and low serum B12 and folate levels. The Schilling test reveals poor absorption of oral vitamin B12. What is the most likely diagnosis?