A 55-year-old woman presents with generalized itching and jaundice. She has been feeling fatigued for several months but has been too busy to see a doctor. She has a history of hypothyroidism and received a blood transfusion 10 years ago. On examination, she has xanthelasma, scratch marks, and jaundiced sclerae. Her BP is mildly elevated, and her BMI is 28. Investigations reveal elevated IgM, positive anti-mitochondrial antibodies, and abnormal liver function tests. What is the most likely diagnosis?
MRCP2-1760
A 38-year-old man presents with a six-month history of experiencing a tight burning sensation behind his sternum. He reports that this sensation is usually triggered by consuming heavy meals and lying down. The patient denies any dysphagia, melaena, vomiting, or weight loss. His abdominal examination, including a rectal examination, is unremarkable. He is not taking any regular medication and has not been using non-steroidal anti-inflammatory agents. The patient has followed his GP’s advice and has stopped smoking and improved his diet. What would be the appropriate next step in managing this patient’s condition?
MRCP2-1761
A 38-year-old female patient presents to the clinic for follow-up. She has peripheral calcinosis, sclerodactyly, and multiple telangiectasia, especially noticeable on her face. Lately, she has been experiencing worsening heartburn and occasional regurgitation of acid into her throat. What is the most effective course of action for managing her gastrointestinal symptoms?
MRCP2-1762
A 45-year-old male with a 12-year history of ulcerative colitis (UC) presented with right upper quadrant pain and pruritus. He has noticed pale stools recently. He is currently taking sulfasalazine and has had two minor relapses in the past. On examination, he has five spider naevi on the upper trunk, a 5 cm hepatomegaly, and a tippable spleen, but no ascites. Laboratory investigations revealed thrombocytopenia, prolonged prothrombin time, elevated serum bilirubin, aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase. Hepatitis B surface antigen was negative. What is the most likely diagnosis?
MRCP2-1763
A 65-year-old man with a history of hypertension, gastric ulceration, and partial gastrectomy 12 years ago presents to accident and emergency with upper abdominal pain, nausea, and diarrhea that has been ongoing for 4 days. He has been admitted to the hospital twice in the past 8 months with similar symptoms and has lost approximately 5 kg in weight over this time. His current medication includes atenolol 50 mg once daily and omeprazole 20 mg once daily. Blood tests reveal elevated white cell count, low platelets, low potassium, high random glucose, and elevated alkaline phosphatase. His 3-day fecal fat excretion is also elevated. What is the most likely cause of his symptoms?
MRCP2-1764
A 45-year-old teacher returns from a trip to South America, where she volunteered at a local school, presenting with severe bloody diarrhea. She is admitted through the Emergency Department with abdominal swelling, dehydration, and a fever of 38.6 °C. Her blood pressure is 112/64 mmHg with a 25 mmHg drop upon standing, resulting in an increased heart rate. The following investigations were conducted: Haemoglobin (Hb) 102 g/l 135 – 175 g/l Erythrocyte sedimentation rate (ESR) 90 mm/h 1 – 20 mm/h Albumin 30 g/l 35 – 55 g/l pANCA (Perinuclear Antineutrophil Antibodies) Positive Abdominal X-ray Dilated large bowel with evidence of mucosal oedema Stool Negative microscopy and culture
What is the most likely diagnosis based on this clinical presentation?
MRCP2-1765
A 57-year-old woman with a history of alcoholic liver disease and chronic hepatitis C virus infection presented to the clinic. Despite previous failed interferon alpha therapy and continued alcohol consumption, she attended regular check-ups every six months for liver ultrasounds and alpha fetoprotein levels. Recently, she reported a decreased appetite and increasing lethargy. The patient also had a long-standing history of depression following her mother’s death from ovarian cancer fifteen years ago, which led to increased alcohol consumption and job loss as a primary school teacher.
During examination, the patient appears cachectic and pale, but not jaundiced, with no liver flap. Her pulse was 90 beats per minute, blood pressure was 110/65 mmHg, and heart sounds were normal. The abdomen was soft and non-tender, with marked hepatomegaly and shifting dullness.
Further investigations revealed a low haemoglobin level, high MCV, low white cell count and platelets, high international normalised ratio, low serum albumin, high serum total bilirubin, high serum alkaline phosphatase, high serum gamma-GT, and extremely high serum alpha-fetoprotein levels. Additionally, the patient had elevated serum CA-125 and CA19-9 levels.
What is the most likely diagnosis?
MRCP2-1766
You are requested to assess a 56-year-old female patient who underwent a 4-unit blood transfusion a week ago for an acute upper GI haemorrhage related to a duodenal ulcer. She has developed several petechial haemorrhages and her platelet count has dropped to 35 x109/l from 152 x109/l post-surgery. Her blood pressure is 121/82 mmHg, pulse is regular at 75/min. She has an abdominal laparotomy scar with dressing and active bowel sounds. There is a widespread petechial rash on her abdomen and bruises on her arms and legs. What is the most probable diagnosis?
MRCP2-1767
A 39-year-old male patient arrives with a complaint of frank haematemesis. Due to a language barrier, obtaining a medical history is not possible. Upon examination, the patient is in shock with a heart rate of 110 beats per minute and a blood pressure of 95/70 mmHg. Palmar erythema and spider naevi are present. Abdominal examination reveals ascites and splenomegaly with epigastric tenderness. What is the probable diagnosis?
MRCP2-1768
A 67-year-old woman complains of right upper quadrant pain, chills, a fever of 38.5 °C and abnormal liver function tests. An ultrasound of the abdomen reveals no gallstones in the common bile duct, but there are enlarged intra- and extrahepatic bile ducts. What is the probable diagnosis?