Archives: MRCP Part 2

MRCP2-1724

You are on call and have been referred a 45-year-old woman with abdominal pain and increasing abdominal girth. Her symptoms have been progressing over several months.
There is no history of jaundice. She has a past history of pulmonary embolism for which she was treated with warfarin six years ago.
On examination she has mildly jaundiced sclerae. She is alert and orientated, there is no encephalopathy. Abdominal examination reveals ascites and hepatosplenomegaly. You arrange an abdominal ultrasound scan with Dopplers which demonstrates and confirms hepatosplenomegaly and moderate ascites.
What is the three year survival in a patient who has this chronic condition?

MRCP2-1725

A 28 year-old adopted woman presents to her GP with a two week history of blood in her stools. She reports having loose stools and 2-3 bowel movements per day for the past three months. Her medical history includes osteomas of her left tibia and skull. She has a brother with ulcerative colitis. She smokes five cigarettes per day and drinks 10 units of alcohol per week. She works as a lawyer. What is the most probable diagnosis?

MRCP2-1726

A 50-year-old man presents to the emergency department with shortness of breath.

He reports several months of worsening diarrhoea and is now passing over 10 watery motions per day.

On examination, he is dyspnoeic at rest. The blood pressure is 104 / 77 mmHg and the pulse rate is 90 bpm and regular. Oxygen saturations are 93% on room air. Chest auscultation reveals widespread mild polyphonic wheeze and bibasal crackles. Jugular venous pressure is elevated and C-V waves are present. There is a pansystolic murmur at the left lower sternal border louder in inspiration. There is a palpable liver edge 2 cm below the costal margin.

What is the most likely underlying heart valve pathology?

MRCP2-1727

A 65-year-old woman presented with symptoms of carcinoid syndrome 6 months ago and has been on Octreotide therapy. However, her daughter brought her to the clinic today due to confusion, visual hallucinations, and worsening diarrhea. She also complained of an itchy rash on her hands and neck that did not improve with emollients and topical corticosteroids. On examination, she had an erythematous, scaly rash on the dorsum of both hands and around the neck, and an abbreviated mental test score (AMTS) of 4/10. What is the most likely diagnosis?

MRCP2-1728

A 65-year-old man presents with several symptoms indicative of the carcinoid syndrome. The suspicion is that he may have malignant carcinoid syndrome, with the gastrointestinal tract being the most probable origin of the tumours. What is the likely source of these malignant carcinoid tumours in the gastrointestinal tract?

MRCP2-1729

A 50-year-old man presents to the emergency department with shortness of breath.

He reports several months of worsening diarrhoea and is now passing over 10 watery motions per day.

On examination he is dyspnoeic at rest. The blood pressure is 104 / 77 mmHg and the pulse rate is 90 bpm and regular. Oxygen saturations are 93% on room air. Chest auscultation reveals widespread mild polyphonic wheeze and bibasal crackles. Jugular venous pressure is elevated and C-V waves are present. There is a pansystolic murmur at the left lower sternal border louder in inspiration. There is a palpable liver edge 2 cm below the costal margin.

Which investigation is most likely to confirm the diagnosis?

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?