Archives: MRCP Part 2

MRCP2-1205

A 42-year-old woman presents to the hospital with acute epigastric abdominal pain that radiates to her back and nausea. The medical team suspects acute pancreatitis and initiates intravenous fluids. The patient’s vital signs are stable with a blood pressure of 130/75 mmHg, pulse of 90 bpm, and oxygen saturation of 96%.

Laboratory tests are conducted and reveal:

– Hemoglobin (Hb): 13.8 g/l
– Platelets: 190 * 109/l
– White blood cells (WBC): 8.9 * 109/l
– Sodium (Na+): 140 mmol/l
– Potassium (K+): 4.1 mmol/l
– Urea: 4.3 mmol/l
– Creatinine: 95 µmol/l
– Bilirubin: 11 µmol/l
– Alkaline phosphatase (ALP): 40 u/l
– Alanine transaminase (ALT): 35 u/l
– Gamma-glutamyl transferase (γGT): 45 u/l
– Albumin: 49 g/l
– Triglycerides: 12.5 mmol/l
– High-density lipoprotein (HDL) cholesterol: 1.2 mmol/l
– Low-density lipoprotein (LDL) cholesterol: 3.6 mmol/l

What is the most appropriate management plan for this patient’s condition?

MRCP2-1206

A 65-year-old man with type 2 diabetes presents for a check-up. He is currently taking the maximum doses of metformin and gliclazide, and has previously tried a DPP-4 inhibitor and pioglitazone. After discussion, it is decided to add insulin to his treatment plan. His latest Hba1c is 66 mmol/mol (48 mmol/mol), and he is capable of self-injecting after counseling.

As per NICE guidelines, what would be an appropriate insulin regimen to initiate in this patient?

MRCP2-1207

A 79-year-old man is being assessed on the ward after being admitted with recurrent falls four days ago. He has been diagnosed with symptomatic postural hypotension, with a drop of 50 mmHg in systolic blood pressure upon standing. The patient has a medical history of hypertension, osteoporosis, radial fracture, and COPD. He was previously taking ramipril and amlodipine, as well as inhalers and calcium supplements. Despite discontinuing all antihypertensives upon admission, the physiotherapists are unable to mobilize him due to worsening symptoms upon standing. At rest, his blood pressure is 150 mmHg systolic. What is the most appropriate course of action?

MRCP2-1208

A 60-year-old woman has been referred to the endocrinology clinic by her GP due to a lump in her neck. She has not experienced any symptoms of hyperthyroidism or hypothyroidism. Upon examination, she has a painless solitary thyroid nodule and is clinically euthyroid. A fine needle biopsy has confirmed follicular carcinoma of the thyroid. What is the initial treatment that she should receive?

MRCP2-1209

A 63-year-old taxi driver presents at the diabetes clinic six weeks after experiencing an inferior myocardial infarction, which was treated with stenting. He is currently taking metformin 1g twice a day for blood sugar control, as well as ramipril and indapamide. During the examination, his blood pressure is measured at 139/85 mmHg, his pulse is regular at 84 beats per minute, and bilateral basal crackles are heard on chest auscultation, indicating cardiac failure.

Lab results show:
– Na+ 140 mmol/l
– K+ 4.5 mmol/l
– Urea 7.2 mmol/l
– Creatinine 112 µmol/l
– HbA1c 64 mmol/mol

What is the most appropriate course of action for managing his blood sugar levels?

MRCP2-1210

A 65-year-old patient comes for a follow-up appointment at the diabetes clinic. He has been diagnosed with type 2 diabetes for a decade and has a medical history of appendectomy, kidney stones, previous tibial fracture, and depression (now in remission). He is currently taking metformin and gliclazide and has no known allergies. His HbA1c level is 40 mmol/mol, and his urine dip test is negative for glucose and protein. However, his blood pressure reading is 151/96 mmHg. Despite previous attempts to manage his blood pressure through diet and exercise, he has been unsuccessful. The patient is a white Caucasian. What is the most appropriate course of action for managing his blood pressure?

MRCP2-1211

A 25-year-old man has been diagnosed with type 1 diabetes mellitus following an episode of diabetic ketoacidosis. He is currently in stable condition with normal blood sugar levels. What is the recommended initial insulin regimen for him?

MRCP2-1212

A 65-year-old man presents to his primary care physician complaining of excessive thirst and frequent urination. He has a medical history of ischemic heart disease and MELAS syndrome. His current medications include aspirin, atenolol, and atorvastatin. Upon examination, no abnormalities are found. Laboratory tests reveal elevated levels of creatinine and urea, as well as a decreased eGFR. What is the best course of action for managing this patient’s condition?

MRCP2-1213

A 52-year-old male teacher presents to the outpatient clinic with complaints of painful eyes and worsening vision over the past four weeks. Upon examination, he displays proptosis, periorbital edema, and a painful complex ophthalmoplegia. The patient appears anxious and expresses concern about his ability to perform his job. He currently smokes ten cigarettes per day.

What is the most suitable course of action for managing this patient?

MRCP2-1214

A 72-year-old woman presents to the emergency clinic after her GP noticed low sodium levels in a routine blood test. Her electrolyte levels are as follows:

Na+ 120 mmol/L (135 – 145)
K+ 4.2 mmol/L (3.5 – 5.0)
Urea 5.6 mmol/L (2.0 – 7.0)
Creatinine 65 µmol/L (55 – 120)

A previous electrolyte check 2 years ago was unremarkable. However, she is currently asymptomatic and shows no signs of peripheral edema. On examination, her jugular venous pulse is visible but not raised, and her mucous membranes are moist. Heart sounds are normal, and her chest is clear on auscultation. Her heart rate is 68 beats per minute, and her blood pressure is 115/75 mmHg.

Further tests reveal a serum osmolality of 275 mOsm/kg (280-285), urine sodium of 42 mEq/L (<20), and urine osmolality of 175 mOsm/kg (50-1200). What is the most appropriate initial management step to increase her sodium levels?