Archives: MRCP Part 2

MRCP2-1747

A 38-year-old man with a 10-year history of ulcerative colitis, previously treated with intravenous hydrocortisone and currently managed with azathioprine, underwent routine screening colonoscopy. Although extensive colitis was observed, there was no active endoscopic inflammation or post-inflammatory polyps, and mapping biopsies showed no histological inflammation. The patient expressed concern about his future risk of colorectal cancer and willingness to undergo surveillance colonoscopy at the recommended time interval. Based on this information, when should the patient schedule his next surveillance colonoscopy?

MRCP2-1748

A 55-year-old man with a history of gout is currently taking allopurinol. He also has Crohn’s disease, which was diagnosed a year ago, and is currently on a daily dose of 20 mg of prednisolone. Despite having no other significant health issues, he has been gaining a considerable amount of weight. Whenever his steroid dose is reduced to 15 mg, he experiences diarrhoea up to four times a day and requires hospitalization for intravenous steroid therapy. This has happened three times so far. To facilitate the taper, you plan to introduce a steroid-sparing agent. However, you need to avoid a particular agent due to its significant interaction with allopurinol. Which agent should be avoided?

MRCP2-1749

A 55-year-old male Chinese patient who has recently relocated to the UK complains of chronic diarrhoea. His family reports that he has been experiencing deteriorating memory loss, depression, and insomnia. Upon examination, you observe dermatitis, tremors, and ataxia. His blood tests show normal full blood count, renal function, liver function, and bone profile. You suspect that he may have a nutritional deficiency. What vitamin is he most likely deficient in?

MRCP2-1750

A 68-year-old woman presents with right upper quadrant pain and jaundice. An abdominal ultrasound reveals a gallstone in the common bile duct and intrahepatic bile duct dilatation. She is scheduled for an endoscopic retrograde cholangiopancreatography (ERCP) to remove the stone. Based on the 2008 British Society of Gastroenterology guidelines for common bile duct stone management, what is the most frequent complication associated with this procedure?

MRCP2-1751

A 45-year-old man with primary biliary cirrhosis and worsening liver function is in need of a liver transplant.

What is a factor that would make him ineligible for the procedure?

MRCP2-1752

A 32-year-old woman with a 10-year history of severe ileo-colonic Crohn’s disease is admitted for evaluation and treatment of a severe flare-up of her condition. She is experiencing severe lower abdominal pain, diarrhea, weight loss, and fatigue, and has recently developed a vesico-colic fistula. She has been taking mycophenolate mofetil (MMF) which had been effective in controlling her symptoms for the past few months, but is now losing its effectiveness. What is the most appropriate next step in steroid-sparing therapy for this patient?

MRCP2-1730

Which viral disease does not lead to a person becoming a carrier?

MRCP2-1731

A 38-year-old man who is currently homeless and has a past of excessive alcohol consumption arrives at the hospital with gradual abdominal distension that is not painful. During the examination, the doctor notices shifting dullness. To determine the nature of the ascitic fluid and identify the potential cause, the medical team performs an ascitic tap and sends the fluid for analysis. As per the guidelines of the British Society of Gastroenterology on ascites management, what is the most effective measurement to utilize for classifying the ascitic fluid?

MRCP2-1732

A 45-year-old patient undergoes endoscopy and a gastric lesion is biopsied. Immunohistochemistry from the lesion shows positive for CD117 (c-KIT). What is the next appropriate step in management?

MRCP2-1733

A 35-year-old female patient presents with non-bloody diarrhoea with mucous and 1-stone weight loss over six weeks. She has had no recent travel except to Italy for a vacation one year ago. All her family and friends are well but her aunt has diarrhoea for which she has to take tablets.

On examination, she appears unwell, her BMI is 22, BP is 120/80 mmHg, heart rate is 80/min and regular. Her abdomen is soft but there is mild tenderness. You suspect inflammatory bowel disease and perform a colonoscopy and biopsy.

Which one of the following findings would most support a diagnosis of ulcerative colitis instead of Crohn’s disease?