Archives: MRCP Part 2

MRCP2-4231

A 65-year-old female smoker presents with a 3-day history of loss of sensation of both her lower legs. She also reports a 1-stone (6.53 kg) weight loss and unresolving cough over the last month. Her chest X-ray shows a large hilar mass, not seen on a chest X-ray from 2 months ago. She has no other past medical history and is not on any medication.

On examination, she has loss of light touch and pain sensation in a stocking distribution, reduced air entry in her right chest, palpable supraclavicular lymph node and a large craggy liver edge.

Investigations reveal the following:

Investigation Result Normal Value
White cell count (WCC) 6.2 × 109/l 4.0–11.0 × 109/l
Haemoglobin (Hb) 116 g/l 115–155 g/l
Platelets (PLT) 347 × 109/l 150–400 × 109/l

What is the most likely diagnosis for this 65-year-old female smoker?

MRCP2-4237

A 35-year-old construction worker presents with a 2-month history of wheezing and shortness of breath associated with working on construction sites and resolving about 8 h after stopping work.

On examination, his BP is 130/80 mmHg, pulse is 78/min and regular and oxygen saturation is 96% on air. He has fine inspiratory crackles and a dry cough. You suspect he is suffering from occupational asthma.

What is the most likely finding on his chest X-ray?

MRCP2-4234

A 35-year-old woman complains of facial flushing and shortness of breath. She experienced these symptoms after dining at a restaurant. She also had itchy skin and tingling lips. During the examination, she had a wheeze and was tachycardic. Although she had no prior food allergies, she ate lasagne and drank wine for dinner. What is the probable diagnosis?

MRCP2-4245

A 27-year-old female patient has come for a follow-up on her asthma management. She reports that her asthma control has deteriorated lately and she is using her Ventolin inhaler once or twice a week. She confirms that she is not taking any other medication for asthma control. She denies any recent sickness, but she does mention that her symptoms worsen in colder temperatures and during physical activity. What would be the most appropriate course of action to take next?

MRCP2-4241

A 35-year-old man presents with sudden onset of right-sided chest pain that occurred while lifting weights at the gym 24 hours ago. He has no significant medical history and is not taking any medications. The pain has improved since onset and he has not taken any painkillers in the past 6 hours. On examination, his blood pressure is 122/78 mmHg, pulse rate is 76 beats per minute and regular, and his oxygen saturation on room air is 98%. Chest auscultation reveals normal breath sounds bilaterally. A chest X-ray shows a small right-sided pneumothorax with a rim measuring less than 1 cm. Which of the following is the most appropriate next step in management?

MRCP2-4235

A 48-year-old man is referred to the hospital due to increasing shortness of breath. He has a history of HIV and is under the care of local GUM consultants but is not currently on any antiretroviral treatment. He reports experiencing worsening shortness of breath for the past two weeks, with breathlessness occurring even with minimal exercise. He also has a non-productive cough and has been feeling lethargic for the past week. Upon examination, he is afebrile, has a blood pressure of 120/89 mmHg, and a slightly elevated heart rate of 110 bpm. His respiratory rate is 18 at rest, and his oxygen saturation is 98% on air. However, when he mobilizes to the toilet, he becomes very tachypnoeic, and his saturations drop to 90%. Blood tests reveal a low hemoglobin level of 110 g/l, normal platelet count of 201 * 109/l, and a slightly elevated white blood cell count of 9.6 * 109/l with neutrophils at 4.5 * 109/l. His electrolyte levels are within normal range, with a slightly elevated CRP level of 70 mg/l. His liver function tests show a slightly elevated bilirubin level of 5 µmol/l, normal ALP level of 89 u/l, and slightly elevated ALT level of 43 u/l, with a low albumin level of 34 g/l. An ABG test shows a pH of 7.35, pO2 of 7.7, pCO2 of 4.6, HCO3- of 21, BE of -3, and lactate level of 2.2. His chest x-ray reveals fine bilateral reticular nodular shadowing. What is the most appropriate treatment for this patient?

MRCP2-4240

A 72-year-old retired bus driver presents to the respiratory fast-track clinic with a two-month history of right-sided chest pain and cough. He was prescribed amoxicillin by his GP, which provided some relief, but he has since developed shortness of breath while walking around his house. The patient has a 30 pack-year smoking history.

Upon examination, the patient has reduced air entry and dullness to percussion on the right lung base. His oxygen saturation is 96% on air. A chest x-ray confirms the presence of a right pleural effusion, and a pleural ultrasound reveals a moderate-sized simple effusion. A pleural aspirate is performed, with the following results:

– Appearance: Serosanguineous
– pH: 7.32
– Protein: 45 g/l
– LDH: 450 IU/l
– Glucose: 4.0mmol/l
– Gram stain: No organisms or malignant cells seen
– Culture: No growth

Based on the patient’s clinical presentation and test results, what is the most appropriate next step in investigating this case?

MRCP2-4238

You are requested to assess a 65-year-old man who has a medical history of chronic obstructive pulmonary disease (COPD) and is scheduled for surgery to repair a significant inguinal hernia. After conducting a thorough examination and taking a detailed medical history, you order some tests before proceeding with the operation. What factor is most closely linked to a higher risk of perioperative complications?

MRCP2-4232

A 68-year-old man who is a heavy smoker and resides in a men’s hostel presents to the Emergency department with back pain. He has been experiencing a persistent cough for the past nine months and has had episodes of haemoptysis. He appears malnourished and disheveled. He smokes 40 cigarettes daily and consumes a bottle of cider every day. He also reports urinary frequency and hesitancy, but no blood in his urine.

The patient undergoes several tests, and the results are as follows:
– Hemoglobin (Hb) level: 104 g/L (normal range: 130-180)
– White blood cell (WBC) count: 11.9 ×109/L (normal range: 4-11)
– Platelet (Plt) count: 342 ×109/L (normal range: 150-400)
– Prostate-specific antigen (PSA) level: 3 µg/L (normal range: <4)
– Chest X-ray reveals cavitating lesions in both upper lobes.
– Lumbar spine X-ray shows suspicious lesions in L3 and L5.
– Sputum microscopy reveals multiple red rods on a blue background.
– Bone biopsy shows caseating granuloma.

What is the most likely diagnosis for this patient?

MRCP2-4239

A 50-year-old construction worker is brought to the hospital with comminuted fractures of the right femur and tibia. No other injuries are observed. After undergoing surgical fixation, he displays signs of aggression and confusion. His vital signs include a temperature of 37.6°C, a pulse rate of 110 beats per minute, a blood pressure of 130/80 mmHg, and a respiratory rate of 25 breaths per minute. He is receiving 45% oxygen, and his SpO2 is at 90%. What is the most probable cause of his symptoms?