Archives: MRCP Part 2

MRCP2-0894

A 49-year-old man is admitted to the Medical Assessment Unit with a pneumonia. He has had a persistent cough for the past week despite taking amoxicillin prescribed by his GP.

His medical history includes alcoholic liver disease and a hepatic transplant 8 months ago, hypertension, and type II diabetes controlled by diet. He has been sober for the past 2 years and has never smoked. He is currently taking ramipril, simvastatin, and tacrolimus.

Upon admission, he has a temperature of 38.1 ºC and oxygen saturation of 94% on air. His heart rate is 110 beats per minute and blood pressure is 105/65 mmHg. Left basal crepitations are heard on auscultation, and a chest x-ray confirms a left lower lobe pneumonia.

The patient is started on intravenous fluids, 2 liters of oxygen via nasal cannulae, co-amoxiclav, and clarithromycin. His statin is withheld.

Two days later, the ward team is called to review the patient as he has developed limb twitching. During the assessment, he experiences a generalized tonic-clonic seizure that requires lorazepam to terminate it.

Which investigation is most likely to reveal the cause of his seizures?

MRCP2-0895

A 42-year-old construction worker is discovered in a distressed state after collapsing while handling chemicals on a job site. Upon arrival at the Emergency department, the patient is confused, experiencing excessive salivation, and has had an episode of urinary and fecal incontinence. The patient is also exhibiting noisy breathing, with a blood pressure of 90/60 mmHg and a pulse rate of 48 beats per minute.

What is the most suitable course of action in this situation?

MRCP2-0896

A 64-year-old man presents to the hospital with a history of several months of weight loss, shortness of breath and a productive cough which was sometimes accompanied by haemoptysis. A chest x-ray had revealed apical consolidation and sputum was positive for acid-fast bacilli, leading to a diagnosis of tuberculosis. The patient has a past medical history of asthma and takes PRN salbutamol and Seretide inhaler twice daily.

One week after being diagnosed, the patient is admitted to the acute medical unit with shortness of breath and bilateral expiratory wheeze. His observations reveal a temperature of 37.1ºC, respiratory rate of 27 breaths per minute and oxygen saturations of 94% on room air. Oxygen is commenced via a face mask. A chest x-ray reveals the same apical consolidation as before, with no new features.

What is the most appropriate next step in his treatment?

MRCP2-0870

A renowned athletics coach recently expressed concern that some of the athletes had abnormally high red cell counts – a sign of using erythropoietin (EPO). He lamented the fact that EPO had been administered to some athletes by their former coaches outside the country and they actually took the drug unknowingly.

What is the most effective method of detecting EPO misuse?

MRCP2-0871

A 46-year-old man, known for begging outside the station, is brought to the Emergency Department by ambulance. He is unconscious and hyperventilating. The nurses inform you that he has a history of alcohol abuse, cataracts potentially related to previous methanol ingestion, and epileptic seizures that have led to multiple hospital admissions. On examination, his blood pressure is 100/70 mmHg, pulse is 100/min regular, and he has crackles on auscultation of both lung fields consistent with cardiac failure. He has nystagmus and does not respond when you try to wake him. There is no smell of alcohol. Investigations reveal abnormal results for haemoglobin, white cell count, platelets, sodium, potassium, creatinine, chloride, bicarbonate, pH, and glucose. What is the most likely diagnosis?

MRCP2-0872

A 60-year-old man visits his GP complaining of enlarged breast tissue that has been present for 8 weeks. He is feeling self-conscious as his clothes no longer fit properly. He denies any breast pain or nipple discharge. His medical history includes hypertension, depression, chronic back pain, and benign prostatic hyperplasia.
During the examination, the patient appears healthy, and all vital signs are normal. There is visible enlargement of breast tissue on both sides, but no tenderness or breast lumps on palpation.
The GP suspects that the patient’s medication may be contributing to his symptoms.
Which medication is most likely responsible for this patient’s presentation?

MRCP2-0873

A 28-year-old car mechanic with a history of episodic abdominal pain, anorexia, constipation, and intermittent nausea and vomiting for the past six months was admitted to a surgical unit for evaluation after a severe episode. He has also experienced weakness in his hands for the past three weeks, making it difficult to use his gadgets. A medical registrar examined him and found weakness in the distal muscles of his limbs, absent tendon stretch reflexes, and flexor plantar responses. The sensory system was intact. The following investigations were conducted: white cell count, haemoglobin, mean corpuscular volume, mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration, erythrocytes, fasting blood glucose, sodium, potassium, and urinalysis. Which of these investigations would confirm the suspected diagnosis?

MRCP2-0874

A 30-year-old man presented to the Emergency Department with a history of abnormal posturing of his torso and neck for the past few hours. He had a history of aggressive behaviour and had been involved in altercations with his colleagues. His family had taken him to a psychiatrist recently and he had started taking antipsychotic medication.

Upon examination, he was afebrile. His neck was in forced extension, there was arching of his back and his arms were internally rotated. There was extension of the elbows and wrists.

What is the accurate description of his clinical presentation?

MRCP2-0875

You are requested to assist in the management of a 25-year-old woman who has been brought to the Emergency Department by her family. Upon examination, she appears restless and disoriented, with dilated pupils, noticeable tremors, excessive sweating, and teeth grinding. Her heart rate is regular at 110 beats/min, and her temperature is 38.2°C. The patient’s deep tendon reflexes are hyperactive. There is no significant medical history, but her family reports that she has been struggling with depression for a while and recently had her medications adjusted by her primary care physician.

What is the probable diagnosis?

MRCP2-0876

A 22-year-old college student presents to the emergency department accompanied by his friends who are worried about his behavior. They found him urinating on the couch in the living room. During the examination, he appeared restless, sweaty, and had occasional muscle spasms.

Vital signs: heart rate 110 beats per minute, blood pressure 165/105 mmHg, temperature 37.9ºC.

Upon reviewing his medical history, it is noted that he is taking citalopram for depression and has recently been prescribed another medication.

Which medication is most likely responsible for his current symptoms?