Archives: MRCP Part 2

MRCP2-4318

A 25-year-old male with asthma presents to the emergency department with acute breathlessness and wheeze following a recent cold. He has received high flow oxygen, regular nebulised bronchodilators and 200 milligrams of intravenous hydrocortisone.
Upon examination, he appears pale and clammy, and is unable to record a peak flow reading. His pulse is 140 per minute, temperature is 37.3°C, and his oxygen saturations are at 86% on 15 L of oxygen. Upon auscultation of his chest, poor breath sounds are heard bilaterally with a faint polyphonic wheeze.
His arterial blood gas on 15L of oxygen reveals:
pH 7.30 (7.36-7.44)
PO2 8.0 kPa (11.3-12.6)
pCO2 7.8 kPa (4.7-6.0)
HCO3 16 mmol/L (20-28)
What is the most appropriate course of action for this patient?

MRCP2-4329

A 49-year-old man, admitted for a routine hernia surgery, was found to have a pneumothorax on his pre-operative chest X-ray. He has a past medical history of chronic bronchitis and a smoking history of 45 pack-years. The chest X-ray reveals a 2.5 cm unilateral pneumothorax. Although he is not experiencing shortness of breath, he is experiencing chest discomfort.
What would be the optimal approach to manage this clinical situation?

MRCP2-4327

A 25-year-old male presents to the Emergency department complaining of chest pain and difficulty breathing. Upon examination, a significant right-sided pneumothorax is identified and promptly treated with chest tube drainage. Interestingly, this patient had a similar episode six months prior, which was also treated successfully with chest tube drainage. He has no history of smoking or any other significant medical conditions. After 24 hours, his lung has fully re-expanded and he is in stable condition. What is the next appropriate step in managing this patient?

MRCP2-4313

A 26-year-old woman with a history of cystic fibrosis presents to the endocrinology clinic for evaluation. She has been experiencing weight loss and her recent fasting plasma glucose level was measured at 8.1 mmol/l. She has had three hospital admissions in the past year due to exacerbations of her CF. On physical examination, her blood pressure is 122/81 mmHg, pulse is regular at 71 beats per minute, and coarse crackles and scattered wheezing are heard on chest auscultation. Her abdomen is soft and non-tender, and her body mass index is 19.5 kg/m². What is the optimal approach to managing her diabetes?

MRCP2-4310

A 79-year-old man with a history of chronic obstructive airways disease (COPD) is being discharged from the hospital after being admitted for an infective exacerbation. He has completed a seven-day course of prednisolone and is no longer on antibiotics. However, his room air Sa02 remains at 91%, indicating hypoxia. The patient’s blood work shows a hemoglobin level of 134 g/l, platelet count of 350 * 109/l, and a white blood cell count of 10.2 * 109/l. Arterial blood gas analysis reveals a Pa02 of 7.8 kPa, PaCO2 of 6.5 kPa, and HCO3- of 30 mmol/L. The patient’s wife inquires about the possibility of having oxygen at home. What additional tests are necessary to determine if this patient would benefit from long-term oxygen therapy?

MRCP2-4312

A 50-year-old woman presents with an increasing cough and shortness of breath that has been worsening over the past year. She has experienced multiple chest infections in the last six months. Although she used to smoke 10 cigarettes a day, she quit eight years ago. She has no known allergies and works as a hairdresser. A chest x-ray came back normal. Pulmonary function testing revealed an FEV1 of 1.60 L (53% predicted), FVC of 2.86 L (78% predicted), total lung capacity of 4.83 L (110% predicted), TLCO of 6.63% (93% predicted), and KCO of 1.36 (120% predicted). What is the most likely diagnosis?

MRCP2-4315

A 26-year-old pregnant woman who is 28 weeks along suddenly experiences shortness of breath and slight left-sided chest pains. She has no cough or haemoptysis and no history of long flights or leg swelling. On examination, she appears anxious with a blood pressure of 110/60 mmHg, pulse rate of 92/min, and respiratory rate of 26/min. Her abdomen is distended, and fetal movements are seen. Investigations reveal a low probability of pulmonary embolism (PE) on a V/Q scan, but her D-dimer levels are elevated. What would be the most appropriate step in her immediate management?

MRCP2-4311

A 55-year-old man presents with a persistent dry cough that is causing him to lose sleep at night. He is also experiencing breathlessness during physical activity and fatigue throughout the day. The patient has a history of heavy smoking (20 cigarettes a day since age 20), is overweight (BMI = 34), and has recently been diagnosed with hypothyroidism. His lung function tests show a decreased FEV1, VC, TLC, TLCO, and KCO. Based on these symptoms and test results, what is the most likely diagnosis?

MRCP2-4306

A 57-year-old man presents to the Medical Admissions unit with a two-week history of a productive cough. He has a medical history of type 2 diabetes mellitus. The patient reports that he developed a cough productive of green sputum shortly after returning from a business trip to the United States. He also complains of persistent retrosternal pain for the last ten days. Despite completing a course of doxycycline prescribed by his GP, he has experienced little symptomatic benefit.

Routine blood tests are ordered, and the patient provides a sputum sample for culture. Provisional results indicate the presence of fungal spores, with full speciation awaited. Based on the likely diagnosis, what is the most appropriate management option?

MRCP2-4314

A 65-year-old patient presents to the Emergency Department with shortness of breath that began last night. He is having trouble providing a history as he experiences pain in his lower jaw when attempting to speak. Upon examination, he appears anxious, febrile, and dyspnoeic. His lower jaw is tender, swollen, inflamed, and oedematous.

What is the initial course of action in managing this patient?