Archives: MRCP Part 2

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?

MRCP2-1734

A 20-year-old female patient complains of fever and jaundice. Upon imaging, a choledochal cyst that was previously undetected is discovered. The cyst is described as a fusiform dilation of the common hepatic duct. According to the Todani classification, what type of choledochal cyst does this represent?

MRCP2-1710

A 26-year-old female presents to the clinic with a few weeks of diarrhoea, passing mucous, feeling tired, and experiencing abdominal discomfort that is relieved by defecation. A blood test is ordered and reveals the following results:

– Na+ 138 mmol/l
– K+ 4.0 mmol/l
– Urea 4.5 mmol/l
– Creatinine 80 µmol/l
– Hb 11 g/dl
– Platelets 320 * 109/l
– WBC 4.0 * 109/l
– CRP 1.0 mg/l
– Tissue transglutaminase antibody negative

Which medication would be the most appropriate for her?

MRCP2-1711

A 75 year-old man presents with a 4 month history of generalised abdominal pain and a change in bowel habit. The abdominal pain is colicky in nature and does not radiate anywhere. He also reports increasing distension of his abdomen and 2 episodes of blood in the rectum several weeks ago. He has recently undergone colonoscopy, which did not reveal anything abnormal. His past medical history includes diabetes type 2 and a heart attack three years ago, for which he needed three stents. His mother died of a stroke when he was 60 and his father died of a heart attack at the age of 55. His current medications include ramipril, aspirin, atenolol, atorvastatin and metformin. He has a 35 year pack history and drinks on average 10 units per day.

Blood tests reveal:

Hb 12.5 g/dL
Mean corpuscular volume (MCV) 82 fl
Platelets 200 * 109/l
WBC 12.9 * 109/l
Na+ 135 mmol/l
K+ 5.3 mmol/l
Urea 8.5 mmol/l
Creatinine 150 µmol/l

Apart from an abdominal x-ray, what is the most suitable investigation?

MRCP2-1712

A 43-year-old female patient visits the gastroenterology clinic for follow-up after being discharged from the hospital. She had been admitted due to a six-week history of frequent bloody diarrhea and abdominal pain accompanied by multiple mouth ulcers. During her hospital stay, she underwent several tests, and a short course of intravenous steroids followed by oral prednisolone was prescribed. The patient reported significant improvement in her symptoms and expressed her desire to continue with medication to maintain remission.

The investigations conducted during her hospitalization revealed no organisms in stool microscopy and culture. Colonoscopy showed patchy inflammation with a cobblestone appearance affecting the ascending and transverse colon and terminal ileum. Colonic histology revealed chronic transmural inflammation, crypt abscesses, and submucosal fibrosis. CT abdomen showed no evidence of intra-abdominal collection, structuring, or abnormal fistulation.

What is the most appropriate medication to maintain disease remission in this 43-year-old female patient?

MRCP2-1713

A 45-year-old man presents to the outpatient department with a 5 month history of fatigue and pruritus. He reports excessive daytime sleepiness and difficulty concentrating at work as an auditor. The itching worsens in hot climates and when he uses a blanket while sleeping. He has a medical history of asthma and dry eyes, and takes beclometasone and antihistamines for the itching. He has no known allergies and no family history of any conditions. He does not smoke and drinks 5-10 units of alcohol per week.

During examination, mild jaundice of the sclera and scratch marks over his upper torso and arms are observed. His abdomen reveals a slightly enlarged spleen and liver, both by 1 cm. Blood tests show elevated bilirubin and alkaline phosphatase (ALP). Autoantibody screening reveals the presence of antimitochondrial antibodies (AMA) and antinuclear bodies (ANA).

What is the most appropriate management strategy to alleviate his symptoms?

MRCP2-1714

A 50-year-old woman presents to the gastroenterology clinic complaining of malaise and itching. Her GP had previously found a persistently elevated alkaline phosphatase over the last year. The patient has a history of rheumatoid arthritis. The results of her anti-mitochondrial antibodies and smooth muscle antibodies tests are positive. What further test is necessary to confirm the diagnosis?

MRCP2-1715

A 50-year-old male with a history of alcohol abuse and liver disease presents with confusion. He drinks at least 40 units of alcohol per week. On examination, he has a Glasgow coma scale of 14 and slight hand flapping. He is jaundiced with spider naevi and palmar erythema. Abdominal examination reveals slight distension but no organomegaly. His lab results show elevated liver enzymes and bilirubin levels. He is started on a rapid detoxification program with diazepam but later found collapsed in the bathroom. Which medication is most likely to improve his level of consciousness?