Archives: MRCP Part 2

MRCP2-0834

A 45-year-old patient is admitted with an overdose of aspirin. She has a history of anxiety and substance abuse. The patient confessed the overdose to her sister and claims she took the overdose about 6 hours ago. According to her sister, she ingested approximately 50 × 500 mg aspirin tablets. She is experiencing abdominal pain and vomiting.

Upon examination, her pulse is 120 bpm regular, respiratory rate 20/min, blood pressure 150/90 mmHg.

Investigations:

Haemoglobin 130 g/l 115–155 g/l
White cell count (WCC) 6.0 × 109/l 4–11 × 109/l
Platelets 200 × 109/l 150–400 × 109/l
Bicarbonate (HCO3-) 18 mmol/l 24–30 mmol/l
Sodium (Na+) 138 mmol/l 135–145 mmol/l
Potassium (K+) 3.2 mmol/l 3.5–5.0 mmol/l
Urea 5.5 mmol/l 2.5–6.5 mmol/l
Creatinine 70 µmol/l 50–120 µmol/l
Acetaminophen 200 µg/ml 10-20 µg/ml
Blood gases on air:
pH 7.32 7.35–7.45
pa(O2) 11.5 kPa 10.5–13.5 kPa
pa (CO2) 3.8 kPa 4.6–6.0 kPa

What is the next course of action in managing this patient?

MRCP2-0835

A 67-year-old woman with a history of depression presents to the Emergency department after taking an overdose of her antihypertensive medication, which she believes is a beta blocker. She reports feeling light headed for a few hours but denies any other symptoms. On examination, her blood pressure is 94/58 mmHg and her pulse is 50. A 12 lead ECG shows a regular rhythm with normal QRS morphology, but a prolonged PR interval with no non-conducted P waves. What is the initial step in managing this patient?

MRCP2-0836

A 28-year-old man presented with a 2-week history of severe, worsening headache, vomiting and double vision. He was HIV-positive and had refused antiretroviral treatment or prophylactic medications. He has a CD4 count of 120 × 106/l (normal range 300–1400).

On examination, his temperature was 37.5°C. There was a right-sided facial nerve palsy.

Investigations:

Investigation Result Normal Values

CD4+ 120 × 106/l 430 – 1690 × 106/l

CT head Two large ring-enhancing lesions, with midline shift

What treatment should be initiated based on the most probable diagnosis?

MRCP2-0837

You are summoned to the Emergency department to assess a 20-year-old man who is suspected to have overdosed on cocaine. He is experiencing chest pain and is highly agitated, with a blood pressure reading of 195/105 mmHg. What is the recommended first-line medication for treatment?

MRCP2-0838

A 25-year-old man has presented to the Emergency Department of a local hospital after ingesting a bottle of antifreeze as part of a dare. Upon arrival, he appears quite ill, with blood tests indicating a significant anion gap metabolic acidosis and an elevated osmolar gap. During examination, his blood pressure is 100/60 mmHg, his pulse is regular at 95 bpm, and he is lethargic. Arterial blood gas analysis reveals a severe metabolic acidosis. While he can be admitted to the high-dependency unit, there are no available ICU beds.

What would be the most appropriate course of treatment for this individual’s antifreeze poisoning?

MRCP2-0839

A 50-year-old woman with bony metastases from breast cancer presents to the Emergency Department with vomiting, dehydration, increasing drowsiness, and confusion over the past five days. She had been able to work part-time for a charity and maintain a good quality of life prior to this week. On examination, she is drowsy and confused, with a BP of 100/80 and a pulse of 88 and regular. Heart sounds are normal, chest is clear, and abdomen is soft, although she appears agitated on abdominal palpation.

Investigations reveal a Hb of 102 g/l (115-160), WCC of 6.8×10(9)/l (4-11), PLT of 148×10(9)/l (150-450), Na of 138 mmol/l (135-145), K of 5.6 mmol/l (3.5-5), Cr of 135 micromol/l (60-90), and Ca of 3.6 mmol/l (2.1-2.65). She is given 1 litre stat of normal saline, and a second litre is commenced.

What is the most appropriate next intervention?

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?

MRCP2-0841

A 28-year-old woman with a history of severe depression has been admitted to the medical admissions unit. She was found unconscious in a locked room at home after not being seen for six hours. There is a strong smell of alcohol. Upon examination, her Glasgow coma score is 7/15 and both pupils are dilated. Her pulse rate is 110 beats per minute and blood pressure is 110/70 mmHg. The patient experiences a grand mal seizure and is intubated and ventilated. An ECG shows sinus tachycardia with prolonged QRS complexes and a significantly prolonged QTc interval. Arterial blood gas analysis reveals metabolic acidosis.

What is the most appropriate initial treatment?

MRCP2-0820

A 38-year-old man presents to the endocrinology clinic concerned about the long-term effects of his previous anabolic steroid use. He had been a competitive bodybuilder for 10 years and had recently stopped using steroids. During his steroid use, he experienced severe acne, gastrointestinal issues, male pattern baldness, erectile dysfunction, and scrotal discomfort. He denies symptoms associated with heart or liver disease but admits to past recreational drug use, including cocaine. On examination, he has moderate pitting edema and mild bilateral gynecomastia. His lab results show elevated HbA1C and LDL cholesterol levels, low HDL cholesterol levels, and elevated prolactin levels. His luteinizing hormone and follicle-stimulating hormone levels are low. A transthoracic echocardiogram is normal. Which of the patient’s unwanted effects will be irreversible after stopping steroid use?

MRCP2-0821

A 28-year-old man presents to his GP with generalised itchiness that has been ongoing for several weeks. Despite trying various over-the-counter creams, the itchiness has persisted and is now affecting his sleep. He has become fatigued and has been late to work as a fitness instructor multiple times. He denies alcohol use and is a former smoker. His GP decides to perform some blood tests to investigate further.

Upon examination, the patient appears well-built and has scleral icterus. There are numerous scratch marks on his torso, and he has mild gynaecomastia. His abdomen is soft with no palpable masses, and there are no spider naevi. His ankles are soft with no oedema, and he has no rashes. His mother has ulcerative colitis with liver complications, but he has no significant past medical history.

Hb: 180 g/l
Platelets: 459 * 109/l
WBC: 9.8 * 109/l
Neuts: 7.2 * 109/l
Lymphs: 1.2 * 109/l
Na+: 145 mmol/l
K+: 3.0 mmol/l
Urea: 4.5 mmol/l
Creatinine: 95 µmol/l
Bilirubin: 45 µmol/l
ALP: 189 u/l
ALT: 61 u/l
γGT: 213 u/l
Albumin: 45 g/l
Anti smooth muscle antibody: negative
Anti liver kidney antibody: negative

Based on these results, what is the most likely cause of the patient’s deranged bloods?