MRCP Part 2 Archive - Page 397 of 479

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?

MRCP2-0805

You are in the general medical clinic. A 35-year-old male has been referred by his GP with dyspnoea. His symptoms started about 6 months ago with dyspnea mostly on exertion which is progressively getting worse. He also has a dry cough for last 3 months. There is no orthopnoea or paroxysmal nocturnal dyspnoea. There is also no history of chest pain. His past history includes Hodgkin’s lymphoma which was successfully treated 3 years ago with ABVD regimen. He is currently not taking any medications. He works in a printing press and does not smoke. On examination, there is no raised JVP or ankle oedema. Auscultation revealed normal heart sounds and bilateral fine crackles. Results of his investigations are as follows:

Hb 120 g/l Na+ 140 mmol/l Bilirubin 10 µmol/l
Platelets 190 * 109/l K+ 4.0 mmol/l ALP 90 u/l
WBC 7.0 * 109/l Urea 4.5 mmol/l ALT 20 u/l
Neuts 3.0 * 109/l Creatinine 90 µmol/l γGT 50 u/l
Lymphs 2.5 * 109/l ESR 30 mm/hr Albumin 35 g/l
Eosin 0.2 * 109/l

Chest x-ray normal

What is the next best investigation for evaluation of this patient?

MRCP2-0806

A 54-year-old man is brought into the emergency department resuscitation room. He was found collapsed by his wife 40 minutes ago. He was last seen 3 hours prior. His wife is present, who informs you his past medical history consists of depression, osteoarthritis, sciatica and ischaemic heart disease.

What is the probable reason for this man’s condition?