Archives: MRCP Part 2

MRCP2-4351

A 68-year-old man presents to the outpatient department with a history of cough and dyspnoea for the past four months. He experiences coughing most mornings and brings up mucoid sputum. He denies any haemoptysis but has become increasingly breathless on exertion, limiting his exercise tolerance to 100 metres on the flat. He reports constant pain in his right shoulder that has started to keep him awake at night over the last couple of months, as well as pain in the medial aspect of his right arm. He has a reduced appetite and has lost 5 kg in weight. He has a forty pack year smoking history and is a retired engineer. He has signs of rheumatoid arthritis in his hands, with bilateral finger clubbing and wasting of small muscles in his right hand, particularly the thenar and hypothenar eminences.

What is the preferred diagnostic test for this patient?

MRCP2-4355

You are evaluating a 75-year-old man in the respiratory clinic who presented to the hospital with worsening dyspnea over several months, which acutely worsened in the days leading up to his admission. He has a history of smoking with a 50 pack year history and no other medical or surgical conditions. On examination, he had reduced breath sounds, expiratory wheeze, and fine bibasal crepitations that did not change with coughing. He was diagnosed with a non-infective exacerbation of newly diagnosed chronic obstructive pulmonary disease and discharged on inhalers. However, his dyspnea persists with an MRC dyspnoea score of 3-4. Further investigations revealed centrilobular emphysematous change in the upper lobes bilaterally, subpleural reticular opacities, and honeycombing in both lung bases. What is the correct diagnosis for this patient’s condition?

MRCP2-4353

A 26-year-old woman with cystic fibrosis (CF) presents to the endocrinology clinic with weight loss and frequent nocturnal urination. She has experienced two exacerbations of her CF in the past year and a decline in lung function. On examination, she has a blood pressure of 122/82 mmHg, a pulse of 82 beats per minute, and a BMI of 19 kg/m². Crackles and wheezing are heard on chest auscultation. Her fasting blood glucose is 8.1 mmol/l, and her HbA1c is 60 mmol/mol. What is the most appropriate management strategy for her diabetes mellitus?

MRCP2-4359

A 67-year-old male presents to the emergency department with dyspnoea. He reports that the dyspnoea is present even at rest and worsened by physical activity. The patient has a medical history of hypothyroidism, recurrent urinary tract infections, and anxiety. His current medications include nitrofurantoin, levothyroxine, paracetamol, bisoprolol, and sertraline. Upon examination, the physician observes basal crepitations and stony dull percussion at the left lung base.

After a chest x-ray, a left-sided pleural effusion is detected. Which medication is the most likely culprit for causing the pleural effusion?

MRCP2-4332

A 35-year-old woman presents with sudden onset of left-sided pleuritic chest pain. She initially thought it was due to lifting heavy boxes at work, but the pain persisted and she became slightly more short of breath. She is tall and thin and has no significant medical history but is a smoker. On examination, she appears comfortable and is not in distress. A clicking sound is heard that is synchronous with the heart sounds. Chest X-ray is normal. What is the best course of management for this patient?

MRCP2-4333

A 22-year-old male presents to the hospital with sudden onset of sharp chest pain and difficulty breathing on the left side. Upon examination, he appears mildly breathless at rest with a regular pulse of 100 beats per minute and blood pressure of 125/60 mmHg. A chest x-ray reveals a left pneumothorax with a visible 4 cm rim of air around the left lung. His oxygen saturation on air is 98%. What is the best course of action for management?

MRCP2-4334

A 85-year-old male presents with his fourth admission of right lower zone community-acquired pneumonia in 6 months. A CT thorax demonstrates a 2.5cm mass in right lower lobar bronchus with no regional lymph nodes. Bronchoscopy reveals non-small cell lung Ca 3.5cm from the carina, CT staging reveals no other metastases. A final staging diagnosis of T1b N0 M0 is made, at stage 1A. The patient undergoes lung function testing as follows:

FVC 2.1l
FEV1 1.6l/s
TLCO 40% of predicted

What is the most appropriate treatment?

MRCP2-4335

A 20-year-old male visits his doctor complaining of a persistent cough and fever for the past 2 weeks. He initially thought it was just a cold, but his symptoms have been getting worse. He is worried because he supports his elderly parents financially, who recently returned from a trip to China. Upon further questioning, he reveals that he has lost his appetite and experiences night sweats that soak his bed sheets. Based on his medical history and physical examination, the doctor suspects tuberculosis and urgently refers him to a Chest Clinic for confirmation. Tests confirm the diagnosis, and the patient is started on standard treatment for pulmonary tuberculosis. However, when he returns to the doctor several weeks later, he reports a decline in his vision since his diagnosis.
What is the most likely cause of this side effect?

MRCP2-4344

A 56-year-old accountant has been referred by his doctor due to complaints of constant fatigue. He has a history of depression and is currently taking antidepressant medication as prescribed by his GP. Recently, he had to resign from his job as he found it difficult to drive long distances and almost got into a car accident due to sudden swerving. He has gained 3 stone in weight over the past three years, which he attributes to his depression. During his check-up, his blood pressure was found to be high at 170/100 mmHg. What investigation is most likely to provide an explanation for his symptoms?

MRCP2-4346

A 26-year-old male employed in a plastic factory complained of experiencing difficulty in breathing. He had just come back from a two-week vacation in Spain where he was in good health. At 2:00 AM, he arrived at the Emergency department after using his salbutamol inhaler eight times. However, he recuperated fully after receiving treatment with a salbutamol nebulizer and steroids. What condition is he most likely suffering from?