Archives: MRCP Part 2

MRCP2-0754

A 43-year-old man with rigors is presented. He had sudden onset of illness 12 hours ago and experienced four episodes of diarrhoea. His home help found him lying on the floor. He was discharged from hospital two weeks ago after being treated for osteomyelitis. His medications included paracetamol, tramadol, fluoxetine and linezolid. On examination, he was confused and agitated, with a temperature of 40.7 °C. His pulse was 142 bpm and regular and his respirations were 32 breaths per minute. Cranial nerve examination revealed rapid sustained eye movements. Peripheral nerve examination demonstrated generally increased tone, rapid contraction and relaxation of his ankle and hyper-reflexia. Investigations revealed abnormal results for sodium, potassium, creatinine, urea, creatine kinase, C-reactive protein, white cell count, haemoglobin, and platelets. The most likely diagnosis is: ____.

MRCP2-0755

A 87-year-old female is admitted to the general medical unit with acute thoracic back pain from a T6 crush fracture following a fall. She has a past history of systolic heart failure, depression and osteoporosis.

Her regular medications included aspirin, frusemide, spironolactone, bisoprolol, sertraline and calcium, vitamin D and weekly alendronate. These are continued throughout her admission.

Four days into her admission, the nurses note that she is agitated and a bit confused.

On examination, she looks flushed and is tachycardic with a heart rate of 120 beats/min and is hypertensive with a blood pressure of 185/70 mmHg, but is afebrile. Both her pupils are mildly dilated, she is mildly tremulous and is noted to have deep tendon hyperreflexia with easily inducible clonus.

Which of the following analgesic medications could be responsible for her current symptoms?

MRCP2-0756

A 25-year-old woman presents to the emergency department with agitation and refusal to answer questions. Her partner reports that she has been increasingly agitated throughout the day and is currently taking sertraline and mirtazapine, but the dosages are unknown. The patient allows for a brief examination, which reveals dilated pupils, brisk reflexes, and myoclonus. Her vital signs show a temperature of 38.8ºC, heart rate of 110/min, blood pressure of 178/102 mmHg, respiratory rate of 25/min, and oxygen saturation of 98% on air. Intravenous fluids and lorazepam are prescribed to calm the patient, but what other treatment should be administered based on the diagnosis?

MRCP2-0719

A 65-year-old man with a history of chronic obstructive pulmonary disease (COPD) presents to the Emergency Department after feeling a sudden snap at the base of his left ankle. He is unable to bear weight or move his foot up and down. He is currently experiencing a COPD exacerbation and was prescribed prednisolone and ofloxacin by an Emergency General Practitioner (EGP). He also takes aspirin, atorvastatin, and ramipril for hypertension and cardiovascular disease. Upon examination, a ruptured Achilles tendon is discovered. What is the most likely cause of this injury?

MRCP2-0720

A 32-year-old man comes to the clinic with visual problems. He reports pain in eye movements and loss of vision on the right side, which has been getting worse for the past 2 days. During the examination, you observe an enlarged blind spot and swelling of the optic disc on the right side. The patient has a medical history of rheumatoid arthritis and active tuberculosis. He is taking rifampicin, isoniazid, pyrazinamide, ethambutol, and hydroxychloroquine.

Which medication is the most likely cause of his symptoms?

MRCP2-0721

A 65 year old farmer is rushed to the Emergency Department after falling into a trough of organophosphate sheep dip. Upon arrival, he is in critical condition with excessive vomiting and producing a large amount of respiratory secretions. His airway is in danger, but he is also restless and challenging to evaluate. His breathing rate is 20 breaths per minute, and his oxygen saturation is 87% on 4L/min oxygen. A wheeze can be heard from the end of the bed. His heart rate is 55 bpm, and his blood pressure is 92/44 mmHg. Heart sounds are normal. He is experiencing urinary and fecal incontinence and severe abdominal pain. He has widespread muscle fasciculation and overall weakness. His pupils are pinpoint.

What is the most accurate description of the toxic effect of organophosphate compounds?

MRCP2-0722

A 65-year-old man is undergoing treatment with linezolid for MRSA bacteraemia. Which of the following drugs may require discontinuation during its administration?

MRCP2-0723

A 23-year-old man is brought to the Emergency Department with a Glasgow Coma Score of 8. He has consumed over 35 units of alcohol in the past 6 hours.

His biochemical results are as follows:

– Sodium: 132 mmol/L (137-144)
– Potassium: 4.0 mmol/L (3.5-4.9)
– Chloride: 90 mmol/L (95-107)
– Bicarbonate: 16 mmol/L (20-28)
– Urea: 7.0 mmol/L (2.5-7.0)
– Creatinine: 95 μmol/L (60-110)
– Glucose: 5.0 mmol/L (4.4-6.1)
– Plasma osmolality: 324 mosm/kg (278-300)

Calculate his osmolar gap.

MRCP2-0724

A 30-year-old African American woman had recently been diagnosed with TB and was started on quadruple anti-TB therapy. She appeared anxious and had difficulty sleeping. She had made several suicide attempts in the presence of family members by ingesting pills, but had been saved each time. She was urgently referred to a psychiatrist. However, she was brought to the Emergency Department in a comatose state with ongoing seizures and nausea.
Upon examination, her temperature was 39 °C, pulse 130/min, and blood pressure 95/60 mmHg.
Based on the clinical presentation, what is the most probable cause of her acute symptoms and signs?

Investigations:

Sodium (Na+) 142 mmol/l 135–145 mmol/l
Potassium (K+) 3.1 mmol/l 3.5–5.0 mmol/l
Chloride 98 mmol/l 98-106 mmol/l
Bicarbonate 22 mmol/l 24–30 mmol/l
pH 7.1 7.35–7.45
Urea 20 mmol/l 2.5–6.5 mmol/l
Creatinine 400 µmol/l 50–120 µmol/l

MRCP2-0725

A 50-year-old woman comes to you complaining of back pain. She has a medical history of gastric ulcer and had a hysterectomy and oophorectomy at the age of 38. Her family has a significant history of osteoporosis. The patient arrives at the Emergency department with sudden and severe back pain that radiates to the front of her chest. A thoracic spine X-ray shows a T5 vertebral crush fracture. What would be the most suitable initial pain management for this patient?