A 30-year-old woman comes to the Gastroenterology Clinic for a review of her Crohns disease management. She was diagnosed at the age of 24 years and has had 6 flares of her disease, two of which have required hospital admission. She was hesitant to start immunosuppressive medication to control her disease but has now agreed to try it. The treatment options are discussed with her and she decides to start monotherapy with azathioprine. She has no significant medical history and no known allergies. What is the next most appropriate test to consider before beginning treatment?
MRCP2-0737
A 56-year-old man comes to the Gastroenterology Clinic for a follow-up on his Crohn’s disease management. He was diagnosed when he was 16 years old and has had multiple flares of his disease, three of which required hospitalization. Initially, he was hesitant to start immunosuppressive medication to control his disease, but he has now changed his mind. The treatment options are discussed with him, and he decides to try monotherapy with azathioprine. He has a medical history of hypertension and gout, for which he takes amlodipine, ramipril, and allopurinol. What additional precautions should be taken before starting his treatment?
MRCP2-0702
A 69-year-old man is admitted to the unit with an exacerbation of severe pain around his abdomen. He describes it as a tight band like pain which is burning in character. He has a past medical history of metastatic prostate cancer. His drug history includes morphine modified release (100mg, twice daily), duloxetine (60mg, twice daily), pregabalin (200mg, three times per day). He states that the pain initially responded well to the analgesics he is on however over the past few weeks it has got progressively worse and culminated in a severe attack of pain today.
Suspecting severe neuropathic pain secondary to spinal metastases, the pain is now poorly controlled with a large dose of opioids and two neuropathic agents. The consultant decides to start him on ketamine. What acute complication should be monitored for?
MRCP2-0703
You are caring for a 65-year-old woman with advanced ovarian cancer. She is experiencing persistent vomiting that has not responded to subcutaneous metoclopramide.
Her blood work shows:
Calcium 4.1 mmol/L (2.1-2.6)
You determine that a syringe driver is necessary. What anti-emetic medication would you recommend?
MRCP2-0704
A 68-year-old woman is seen in the rheumatology clinic for ongoing rheumatoid arthritis that has been difficult to manage. She is currently experiencing flares in several joints and her current medication is not effectively controlling her symptoms.
After careful consideration, her medication is switched to another agent. Prior to starting the new medication, blood tests are conducted and show:
What is the most likely medication that she started?
MRCP2-0705
An older woman was discovered collapsed in a stairwell of a parking lot. A card from an outpatient psychiatry department was discovered in her coat pocket, along with a bottle of procyclidine tablets. She was running a fever (38.2°C), conscious but not responding to instructions. Her blood pressure was 160/105 mmHg, and she had significant muscle rigidity. What is the probable diagnosis?
MRCP2-0706
A 45-year-old woman with a history of schizophrenia resulting in multiple hospitalisations is referred to you in a psychiatry ward. She reports feeling generally unwell for several weeks, with increasing stiffness in her jaws and arms. She has been on haloperidol for the past few years with good symptom control. During examination, her temperature is 38.5°C and BP is 175/85 mmHg. What drug treatments would you consider for her condition?
MRCP2-0707
A 44-year-old man presents with complaints of increasing stiffness in his arms and jaws, along with a mild throbbing frontal headache typical of his known history of migraines. He also has a history of schizophrenia and is currently taking sumatriptan and fluphenazine. On examination, he has pulsatile temporal arteries and a mild increase in tone throughout. His vital signs show a pulse of 90 beats/min, BP of 180/85 mmHg, and temperature of 38.5°C. Laboratory investigations reveal normal values for Hb, WCC, platelets, ESR, plasma sodium, plasma urea, and slightly low plasma potassium. What drug treatments would be appropriate for this patient’s condition?
MRCP2-0708
A 40-year-old man presented with a six month history of agitation and delusions. He had previously seen a psychiatrist who diagnosed him with paranoid schizophrenia and prescribed depot haloperidol, which had greatly improved his symptoms. However, he was recently admitted by his GP due to confusion and increasing drowsiness over the past three days.
Upon examination, the patient was agitated and had a temperature of 38.5°C and blood pressure of 190/110 mmHg. His cardiovascular and chest examination were normal, and there were no signs of enlarged liver, spleen, or kidneys. The patient had severe bilateral rigidity but no tremors. A septic screen came back normal.
What is the most likely diagnosis?
MRCP2-0709
A 22-year-old man is brought to the Emergency Department by the Police with agitation and aggression. He is accompanied by a friend, who reports that they had been out celebrating his cousin’s birthday and that the patient may have ingested something.
The friend recalls the patient complaining of intense stomach pain for some time after he allegedly took the substance, but it soon settled and he seemed in good spirits; talking enthusiastically about seeing vivid colors and patterns. As the night went on, however, he became increasingly disturbed; shouting at other clubgoers and complaining about feeling paranoid and anxious.
On examination, his temperature is 38.9ºC. His pulse is 120 bpm and his blood pressure is 180/95 mmHg. He is difficult to examine due to intermittent aggression, and he has lashed out on several occasions.
In order to ensure his own safety, a decision to sedate the patient is made. The patient is successfully restrained and cannulated but suffers a tonic-clonic seizure shortly afterward. He is given 4mg IV lorazepam, but then suffers a cardiac arrest from which he cannot be resuscitated.