Archives: MRCP Part 2

MRCP2-0851

A 35-year-old man has been prescribed iron supplements to treat his iron deficiency anaemia. He presents to the Emergency Department after taking 30 iron sulphate tablets 4 hours ago. He complains of abdominal pain and vomiting and requests assistance.

Upon examination, he appears unwell but is maintaining his airway. His blood pressure is 95/65 mmHg and his pulse is 100/min regular. While in the department, he becomes increasingly lethargic and experiences profuse diarrhea.

What would be an appropriate initial intervention in this scenario?

MRCP2-0852

A 32-year-old woman presents to the Emergency Department with abdominal pain and vomiting. She admits to taking an overdose of her medication due to feeling depressed. Her medical history includes depression and iron deficiency anaemia. On examination, she is drowsy and her abdomen is tender to palpation. Her arterial blood gas shows a pH of 7.25, p(CO2) of 3.2 kPa, p(O2) of 12.2 kPa, sodium of 142 mmol/l, potassium of 3.8 mmol/l, chloride of 108 mmol/l, haemoglobin of 120 g/l, bicarbonate of 14 mmol/l, base excess of -6.5 mmol/l, lactate of 3.2 mmol/l, and glucose of 12.8 mmol/l. What is the most appropriate initial treatment for this patient?

MRCP2-0853

A 35-year-old woman is admitted from the Emergency Department with increasing confusion over the past few weeks. She works as a painter. She had recently visited her family doctor with increasing headaches, hypersomnolence and abdominal pains.

Upon examination, she has pale conjunctivae and blue lines on her gums. No focal neurology, and abdominal examination is unremarkable.

The following investigations were conducted:
– Haemoglobin (Hb): 98 g/l (normal value: 120-160 g/l)
– White cell count (WCC): 8.5 × 109/l (normal value: 4.0-11.0 × 109/l)
– Platelets (PLT): 170 × 109/l (normal value: 150-400 × 109/l)
– Mean cell volume (MCV): 82 fl (normal value: 76-98 fl)
– Lead level: 56 μg/dl (normal value: < 10 μg/dl) What is the most appropriate initial treatment for this patient?

MRCP2-0854

A 38-year-old woman with a known history of manic-depressive psychosis is admitted unconscious after having been found fitting in the street. Her husband is contacted and reports that they had a serious argument some 7 h ago.

On examination to the Emergency Department, she is hypertonic and has a GCS of 8. Her blood pressure is 95/55 mmHg and pulse is 105/min. Lithium level is measured at 3.2 mmol/l. She is intubated and ventilated.

Investigations:

Investigation Result Normal value

Haemoglobin 121 g/l 115–155 g/l

White cell count (WCC) 6.7 × 109/l 4–11 × 109/l

Platelets 201 × 109/l 150–400 × 109/l

Sodium (Na+) 134 mmol/l 135–145 mmol/l

Potassium (K+) 5.1 mmol/l 3.5–5.0 mmol/l

Creatinine 87 µmol/l 50–120 µmol/l

Lithium 3.2 mmol/l 0.4–1.2 mmol/l

Which of the following initial interventions would be most appropriate in this case?

MRCP2-0855

A 35-year-old graphic designer is brought to the Emergency Department with a decreased level of consciousness and difficulty speaking. She has a history of anxiety and bipolar affective disorder, which has been well-controlled with medication.
Three weeks ago, she started experiencing severe lower back pain and has been taking ibuprofen regularly since then. Her blood pressure is 120/80, pulse is 90 and regular. Her Glasgow Coma Scale (GCS) score is 12. Blood tests on admission show an elevated sodium level of 150 mmol/l, creatinine of 140 μmol/l, and a sertraline level of 200 ng/ml.
What is the most appropriate course of action?

MRCP2-0856

A 35-year-old vagrant is brought to the Emergency Department after being discovered unconscious outside a bar. He is disoriented, hypoxic, and in critical condition.
His BP is 110/80 mmHg, with a pulse of 95/min and regular rhythm. He has a respiratory rate of 30/min. Pulse oximetry shows oxygen saturation levels of 85%. An empty bottle of amyl nitrite is found in his possession.
What is the most effective course of action to reverse his tissue hypoxia?

MRCP2-0857

A 43-year-old homeless man is brought to the Emergency Department after being found unconscious on a park bench. He is hypothermic with a temperature of 35.5 °C, has a heart rate of 55 bpm and regular blood pressure of 101/60 mmHg. He is drowsy and unable to give a coherent history, with noticeably slurred speech. His Glasgow Coma Scale (GCS) score is 12 (E3 V4 M5) and he smells strongly of alcohol. Arterial blood gas shows a pH of 7.21, p(CO2) of 5.1 kPa, p(O2) of 9.8 kPa, and a low bicarbonate level of 13 mmol/l. What is the most appropriate management for this patient?

MRCP2-0858

A 30-year-old woman visited her local doctor in a highly anxious state. The doctor suspects she may have schizophrenia and has prescribed chlorpromazine, as well as scheduling a follow-up appointment at the clinic.

The woman later arrives at the hospital’s Emergency Department with a fever of 39.2 °C, muscle stiffness, rapid heartbeat, and high blood pressure (BP) of 160/95 mmHg. Blood tests reveal elevated levels of creatine kinase (CK) at 400 U/l and alanine aminotransferase (ALT) at 120 U/l.

What is the most appropriate course of treatment for this patient?

MRCP2-0859

A 30-year-old office worker presents to the Emergency Department after intentionally overdosing on a mixture of prescription and over-the-counter medications. She reports taking approximately 20 paracetamol tablets and an unknown amount of her prescribed antidepressant medication. On examination, she is conscious and oriented with a GCS score of 14, pupils are equal and reactive, heart rate is 90 bpm and blood pressure is 130/80 mmHg.

What is the most appropriate next step in managing this patient’s overdose?

MRCP2-0840

A 49-year-old man was admitted to a medical ward after experiencing acute pancreatitis. He was receiving conservative treatment with IV fluids and was not allowed to eat. He was showing signs of improvement until he was found unconscious by the nursing staff 36 hours later. Upon arrival, he was having a generalized tonic-clonic seizure that eventually stopped after receiving 30 mg of diazepam intravenously. What would be the recommended next course of treatment?