Archives: MRCP Part 2

MRCP2-1700

A 55-year-old woman presents with complaints of increasing numbness and tingling in her feet and hands. She has a history of rheumatoid arthritis and has recently developed an ulcer on her left heel after burning it in a hot bath. Depigmented areas are visible on her upper limbs.

Her current medications include low-dose prednisolone, alendronic acid, lansoprazole, paracetamol, indomethacin, methotrexate, and rituximab. Blood tests reveal low hemoglobin and high platelets and white blood cells. Her vitamin B12 and folate levels are low, and her random blood glucose and thyroid-stimulating hormone levels are high.

Which autoantibody would be most indicative of the underlying disease?

MRCP2-1690

A 35-year-old female presents to the emergency department with complaints of increasing lethargy and reduced exercise tolerance over the past 4 days. She also reports dark urine but denies any other symptoms. The patient works as a clerical staff member in the same hospital. Her medical history includes ulcerative colitis, which had been well controlled until a flare-up 2 weeks ago that required the addition of sulphasalazine. On examination, the patient has conjunctival pallor bilaterally, and her abdomen is soft and non-tender. She has a mild systolic murmur and sinus tachycardia of 104 beats/minute. Blood tests reveal Heinz bodies, reticulocytosis, and elevated levels of LDH and CRP. The patient’s Hb is 89 g/L, MCV is 85 fl, platelets are 356 * 109/L, and WBC is 12.1 * 109/L.

What is the most appropriate immediate treatment for this patient?

MRCP2-1691

A 45-year-old patient presents with a perianal lesion that is discharging. During colonoscopy, a small defect is noted at 2 o’clock, 2 cm from the anal verge, which releases a small amount of pus upon palpation. The patient has been experiencing discharge in their underwear for a few months. On rectal examination, there is induration of the anal canal anteriorly. What is the likely diagnosis?

MRCP2-1692

A 14-year-old boy is referred by his pediatrician with unintentional weight loss and frequent nausea. During the appointment, it becomes evident that he has a distorted perception of his body image.
What would be the most effective way to evaluate his nutritional status?

MRCP2-1693

A 56-year-old man presents to the gastroenterology clinic for follow-up of his alcoholic liver disease. He reports abstaining from alcohol for several months but recently had a relapse after receiving distressing news at work. He now feels very unwell and seeks medical attention.

Upon examination, he appears mildly jaundiced and diaphoretic. His heart rate is 119 beats per minute, and his blood pressure is 105/66 mmHg. He is afebrile, and his cardiovascular and respiratory exams are unremarkable. Abdominal examination reveals a tender 2 cm liver edge and shifting dullness.

The patient’s blood tests are as follows:

– Hemoglobin: 105 g/l
– Platelets: 167 * 109/l
– White blood cells: 10.5 * 109/l
– Neutrophils: 5.7 * 109/l
– INR: 1.9
– Bilirubin: 33 µmol/l
– ALP: 220 u/l
– AST: 137 u/l
– γGT: 505 u/l
– Albumin: 29 g/l
– Sodium: 132 mmol/l
– Potassium: 4.4 mmol/l
– Urea: 7 mmol/l
– Creatinine: 105 µmol/l
– CRP: 47 mg/l

The patient is diagnosed with alcoholic hepatitis and admitted to the hospital. What treatment option is most likely to improve his survival?

MRCP2-1694

A 43-year-old man is scheduled for a colonoscopy and polypectomy. He is on warfarin due to a pulmonary embolism diagnosed four months ago and has chronic renal impairment with an eGFR of 25 mls/min. His INR was checked one week ago and was found to be 2.7. Based on the 2008 BSG guidelines on anticoagulant management during endoscopy, what is the best course of action?

MRCP2-1695

A 28 year old man with ulcerative colitis comes to the clinic for a check-up. He has been managing his colitis well since he was diagnosed at 17 years old, with only two flare-ups that required steroids in the past 2 years. He has never been hospitalized and works full time as an engineer.

For the past two years, he has been taking Pentasa (mesalazine) without any issues. During the examination, his height is measured at 180cm, and his weight is 58kg (body mass index 18 kg/m²). His abdomen is soft and non-tender. His most recent colonoscopy was 8 months ago, which showed no active inflammation or suspicious areas.

The patient is concerned about his risk of colorectal cancer since his father passed away from the disease in his 60s. There is no other family history of gastrointestinal issues. How often should he undergo surveillance colonoscopies?

MRCP2-1696

A 56-year-old man with a history of alcoholic liver disease and cirrhosis is being reviewed on the ward. He was admitted one week ago with decompensated liver disease and had an ascitic drain sited, which has drained 8 litres. His current medications include furosemide, lactulose, and spironolactone. On examination, he appears hypovolemic with a blood pressure of 88/65 mmHg and heart rate of 110 beats per minute. His abdomen is soft and non-tender, and his chest sounds clear.

Blood results from 7 days ago show a Hb of 115 g/l, Na+ of 138 mmol/l, and Bilirubin of 116 µmol/l, among other values. Blood results from today show a decrease in Hb to 112 g/l, Na+ to 128 mmol/l, and Albumin to 11 g/l, among other values. The ascitic tap results show a neutrophil count of 140 cells per mm^3.

What is the most likely diagnosis for this 56-year-old man?

MRCP2-1697

A 61-year-old man with a history of hepatitis C-related cirrhosis presents for his routine outpatient visit. He reports a weight loss of 5 kg since his last appointment four months ago, and you observe that his abdomen appears larger than expected for his frame. The patient denies any change in his abdominal girth. During the physical exam, you note splenomegaly, shifting dullness, and an inability to palpate the liver edge due to abdominal distension. The patient has had recent liver function tests, which you compare to his previous results. Which of the following findings suggests that he may have developed hepatocellular carcinoma?

Investigation Today Four months ago Normal Value
Alanine aminotransferase (ALT) 59 IU/l 62 IU/l 5–30 IU/l
Alkaline phosphatase (ALP) 220 IU/l 117 IU/l 30–130 IU/l
Bilirubin 22 μmol/l 17 μmol/l 2–17 µmol/l
Albumin 26 g/l 35 g/l 35–55 g/l

MRCP2-1698

A 50-year-old woman with a history of asthma presents to the Emergency Department with wheezing and difficulty breathing, but no signs of fatigue. She receives nebulized salbutamol, IV steroids, and high-flow oxygen, but her shortness of breath persists. The charge nurse wonders if administering IV magnesium is appropriate. Based on the BTS guidelines, what would be a valid reason to administer IV magnesium at this point?