Archives: MRCP Part 2

MRCP2-4405

A 56-year-old man presents with a confirmed right adenocarcinoma of the bronchus. He reports weight loss over the past few months and a persistent cough, but is still able to work and care for his family. The following investigations were conducted:

Haemoglobin (Hb): 130 g/l (normal range: 115-155 g/l)
White cell count (WCC): 6.2 × 109/l (normal range: 4.0-11.0 × 109/l)
Platelets (PLT): 180 × 109/l (normal range: 150-400 × 109/l)
Sodium (Na+): 142 mmol/l (normal range: 135-145 mmol/l)
Potassium (K+): 4.2 mmol/l (normal range: 3.5-5.0 mmol/l)
Creatinine (Cr): 110 μmol/l (normal range: 50-120 μmol/l)

Which of the following tests would be most useful in determining his eligibility for surgery?

MRCP2-4406

A 50-year-old male presents to the emergency department with a worsening cough and breathlessness that has been going on for the past four weeks. He reports a productive cough with haemoptysis and admits to fevers and weight loss over this time.

His medical history includes type 2 diabetes mellitus. He currently smokes 20 cigarettes per day and drinks approximately 60 units per week.

Upon examination, an unkempt, cachectic man is observed with bronchial breath sounds in the right upper zone.

The chest X-Ray shows right upper lobe consolidation with a ‘bulging fissure sign’. What is the most likely causative organism?

MRCP2-4407

A 65-year-old man with a recent diagnosis of idiopathic pulmonary fibrosis is seen in respiratory clinic for follow-up after initial baseline investigations. He has been experiencing worsening shortness of breath for the past nine months along with a non-productive cough. Despite attempts by his GP to treat him with inhalers and antibiotics, his symptoms have not improved. The patient has a medical history of hypertension, depression, and gout, and is understandably anxious about his prognosis. What is the most effective test for determining prognosis in this case?

MRCP2-4408

A 29-year-old female patient presents to your clinic with a persistent cough that worsens at night, wheezing, and difficulty breathing for the past two months. She has been producing brownish mucous plugs and has recently experienced fatigue during normal activities. Additionally, she has had episodes of haemoptysis in the last two weeks. The patient has a family history of atopy and had asthma in the past, which she has outgrown. On examination, she appears slightly dyspnoeic at rest, with an expiratory wheeze being the only significant finding. Her respiratory function tests reveal a Forced Expiratory Volume of 1.40 L, Forced Vital Capacity of 2.90 L, and Peak Expiratory Flow Rate of 200 L/min. The chest radiograph shows dilated bronchioles with a shadow in the mid-lung zones. What is the most likely diagnosis?

MRCP2-4409

An 80-year-old man presents to the emergency department with hemoptysis. He has a past medical history of hepatitis C. He declined anti-viral therapy.

On examination, he has a saddle nose deformity. There is a non-blanching rash on his lower limbs.

Blood tests:

Hb 88 g/L Male: (135-180)
Female: (115 – 160)
Platelets 489 * 109/L (150 – 400)
WBC 8.2 * 109/L (4.0 – 11.0)
Na+ 138 mmol/L (135 – 145)
K+ 4.2 mmol/L (3.5 – 5.0)
Urea 18.2 mmol/L (2.0 – 7.0)
Creatinine 155 µmol/L (55 – 120)
CRP 151 mg/L (< 5) Urinalysis: Blood +
Protein +++

Plain radiography of the chest demonstrates bilateral infiltrates.

What test is most likely to be positive given the probable diagnosis?

MRCP2-4410

A 38-year-old woman with a history of tuberous sclerosis presents to the respiratory clinic with worsening dyspnea. Her primary care physician ordered a chest x-ray which revealed significant alterations. What is the complication that has arisen?

MRCP2-4411

A 68-year-old man is referred to the hospital by his GP due to a 6-day history of productive cough and shortness of breath. He is able to speak in full sentences without difficulty.

His vital signs are as follows: heart rate of 98 beats per minute, blood pressure of 110/79 mmHg, respiratory rate of 27 breaths per minute, and a temperature of 38.2°C.

Laboratory investigations reveal a hemoglobin level of 125 g/L (normal range: 130-180), a white blood cell count of 18.7 ×109/L (normal range: 4-11), neutrophils of 16.1 ×109/L (normal range: 1.5-7.0), platelets of 479 ×109/L (normal range: 150-400), sodium of 123 mmol/L (normal range: 137-144), potassium of 3.8 mmol/L (normal range: 3.5-4.9), urea of 8.1 mmol/L (normal range: 2.5-7.5), creatinine of 115 μmol/L (normal range: 60-110), and a CRP level of 210 mg/L (normal range: <10). Based on the severity index CURB-65, what is the severity of pneumonia demonstrated by this patient?

MRCP2-4412

A 32-year-old man weighing 225 kg was referred for investigation of breathlessness before his gastropexy operation. He reported feeling short of breath after walking just 100 yards and also complained of a non-productive cough upon waking each morning. The patient had a medical history of type 2 diabetes mellitus and childhood asthma and rhinitis. He smoked 20 cigarettes per day and consumed at least 10 units of alcohol every evening. He lived with his father who had kept pigeons for the past five years. Full pulmonary function tests were conducted, and the results are shown below. Based on this information, what is the most likely cause of his breathlessness?

Actual % predicted
FVC (l) 3.72 61
FEV1(l) 3.05 64
FRC (l) 1.42 34
RV (l) 1.01 45
TLC (l) 4.94 60
DLCO (ml/m/mm Hg) 29.13 61
DLCO/VA 4.95 94

MRCP2-4413

A 54-year-old man comes to the respiratory clinic complaining of a dry cough and shortness of breath that have been progressively worsening over several months. He has a medical history of hypertension and depression, takes only ramipril, and has no allergies. During the examination, bilateral inspiratory crackles are heard at both lung bases. A chest X-ray reveals extensive pleural plaques. The patient worked as an electrician 20 years ago and suspects that he may have been exposed to asbestos. Asbestosis with extensive pleural plaques is suspected. What are the expected results of his pulmonary function tests?

MRCP2-4414

A young couple, Mr and Mrs Y, seek your advice. Mrs Y is currently six weeks pregnant. Mr Y’s sister and her partner had a child with cystic fibrosis. After being screened, Mr Y was found to carry the DF508 mutation for cystic fibrosis. Mrs Y is hesitant to undergo testing. Given that the gene frequency for this mutation in the general population is 1/20, what is the likelihood of their child having cystic fibrosis?