Archives: MRCP Part 2

MRCP2-4357

A 67-year old male with metastatic small cell lung cancer presents with an acutely swollen leg. An ultrasound scan reveals a femoral vein deep vein thrombosis. Later in the day, he experiences pleuritic chest pain and SOB but neglects to inform the nursing staff. As his condition worsens, he becomes tachypnoeic and his oxygen saturation level drops to 88% on air. On auscultation, he has a wheeze bilaterally and reduced air on the left with hyper-resonant percussion note. An urgent CT thorax is requested, which shows a large 5 cm pneumothorax, bilateral segmental PE’s, left-sided 4x3x2 cm lung cancer (unchanged from last scan one month ago), and bibasal atelectasis. The patient stabilizes after a chest drain is inserted. What is the most likely cause of the pneumothorax?

MRCP2-4358

A 57-year-old woman comes to the clinic for a follow-up after undergoing investigations and MDT consultation. She experiences chronic exertional dyspnoea and has been diagnosed with idiopathic pulmonary fibrosis based on spirometry results showing a restrictive pattern and changes observed on high-resolution CT scanning. What medications are available to modify the progression of the disease?

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?

MRCP2-4360

A 31-year-old man presents to the acute medical unit with sudden onset of shortness of breath. Upon admission, blood cultures reveal the presence of Staphylococcus aureus. During examination, a pansystolic murmur is heard loudest over the left sternal edge. A chest x-ray confirms the presence of a cavitating mass in the right lung with an associated pleural effusion. You perform a pleural tap and obtain the following results:

pH 7.15
Protein 42 g/l
Appearance Serous

What test can be conducted to determine if the effusion is an empyema?

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?

MRCP2-4345

A 56-year-old man has been referred to a medical professional by his GP due to constant fatigue. The patient has a history of depression and is currently taking antidepressant medication. He recently quit his job as a sales representative due to feeling too tired to drive long distances, and had a near-accident while driving. The patient has gained 3 stone in weight over the past three years and has elevated blood pressure at 170/100 mmHg. What is the probable diagnosis?