Archives: MRCP Part 2

MRCP2-4206

A 56-year-old man with a history of allergic rhinitis and adult onset asthma presented to the respiratory clinic with worsening breathlessness, wheezing, and abdominal pain over the past six months. Despite being on high dose inhaled corticosteroids, his asthma was no longer well controlled. He was recently admitted for acute coronary syndrome, but his coronary angiogram was normal. On examination, he had a purplish rash on his abdomen and lower extremities, and bilateral polyphonic wheezing was heard on chest auscultation. Laboratory investigations revealed elevated eosinophils, an elevated erythrocyte sedimentation rate, and positive P-ANCA. What is the most likely diagnosis?

MRCP2-4207

A 35-year-old man comes to the Emergency Department complaining of severe cough, shortness of breath, and unexplained weight loss. He has a medical history of asthma and nasal polyps and has visited his GP thrice in the past 6 months for chest infections, for which he was prescribed antibiotics.

What are the expected blood test results for this patient, considering the probable underlying diagnosis?

MRCP2-4208

A 54-year-old woman visits the respiratory clinic due to experiencing breathlessness. Her GP referred her after noticing breathlessness and a chest X-ray showing right pleural effusion. The patient had recently undergone a right-sided wide local excision with axillary clearance for ductal carcinoma in situ.

Upon examination, the patient has reduced breath sounds on one side with dullness on percussion and tracheal deviation away from that area of her chest. A pleural aspirate is taken and appears milky white in color. The two potential diagnoses are chylothorax and pseudochylothorax.

What diagnostic test would be helpful in distinguishing between chylothorax and pseudochylothorax?

MRCP2-4209

A 34-year-old HIV-positive man presented to hospital with increasing shortness of breath and cough, as well as slightly worse vision over the last few weeks. He had a prolonged admission 4 months ago for a chest complaint and has been taking prophylactic co-trimoxazole. He is a current smoker with a 10-pack year history. On examination, he appeared unwell with a pulse of 110/min, respiratory rate of 28/min, BP of 95/65 mmHg, and saturations of 91% on air. Auscultation of his chest revealed fine crackles bilaterally, and the CXR showed reticular shadowing throughout both lung fields. His investigations revealed a low haemoglobin level, low white cell count, low CD4+ count, and elevated bilirubin, AST, and ALP levels. His TLCO was 80% predicted. What is the likely diagnosis?

MRCP2-4210

A 47-year-old man with a 20-year history of smoking 20 cigarettes a day is admitted to the hospital with increasing breathlessness, coughing up purulent sputum, and left-sided chest pain. He has also experienced poor appetite and decreased intake of food and water over the past two days. The patient has a history of hypertension and takes bendroflumethiazide 2.5 mg once daily. His father died of bronchial carcinoma at age 68, and he works as a plumber while drinking four pints of beer each night. On examination, he has a temperature of 38.5°C, a respiratory rate of 26 breaths per minute, and an area of bronchial breathing at the left base with associated coarse crackles. Investigations reveal abnormal levels of haemoglobin, white cell count, platelets, serum sodium, serum potassium, serum urea, and serum creatinine. The chest x-ray shows an area of dense consolidation in the left lower zone. Which of the following is not a factor associated with a poorer prognosis in community-acquired pneumonia?

MRCP2-4211

A 70-year-old South African woman with a history of rheumatoid arthritis presented to the hospital with a cough, night sweats, and weight loss over the past three weeks. Despite treatment with amoxicillin by her general practitioner, her symptoms persisted and she developed haemoptysis, leading to admission. The patient had been on maintenance prednisolone and received infliximab four weeks prior for a flare-up of her rheumatoid arthritis. Her husband, who usually cared for her, was hospitalized with influenza. She had never smoked and worked as a missionary in South Africa and Zimbabwe. On examination, she appeared cachexic, had a fever of 38.4°C, a blood pressure of 180/100 mmHg, a pulse of 120 beats per minute, and oxygen saturations of 89% on room air. Lung auscultation revealed bronchial breath sounds in the left upper zone, and a chest radiograph showed cavitating left upper lobe consolidation. What is the most likely diagnosis?

MRCP2-4212

A 65-year-old asthmatic patient is brought to the emergency department with wheezing and difficulty breathing, but is not yet displaying signs of exhaustion. The patient is receiving ongoing nebulized salbutamol, IV steroids, and high-flow oxygen. The nursing supervisor asks if administering IV magnesium is appropriate at this point. Based on the BTS guidelines, what factors would suggest that IV magnesium is not necessary at this stage?

MRCP2-4213

A 60-year-old man visited the clinic complaining of breathlessness, wheezing, and a non-productive cough that had persisted for six months. Despite being prescribed a salbutamol inhaler by his GP, his symptoms had not improved significantly. The patient had previously worked in a coal mine for 20 years and had a smoking history of twenty packs per year since the age of 20. He was particularly worried as his father had died of emphysema at the age of 65.

During the clinical examination, the patient’s chest was hyperinflated with reduced breath sounds, scattered rhonchi throughout the chest, and a prolonged expiratory phase. Heart sounds were quiet, and no murmurs were detected. Abdominal examination was normal. Spirometry results showed an actual FVC of 3.2 L (98% predicted), an actual FEV1 of 2.0 L (70% predicted), and an FEV1/FVC ratio of 62.5.

Which of the following options provides the strongest evidence for a COPD diagnosis?

MRCP2-4214

Among these patients with lobar pneumonia, which one has the bleakest prognosis?

MRCP2-4201

A 20-year-old student came to the clinic complaining of sudden onset of left-sided chest pain and difficulty breathing. He had a history of cardiac surgery during childhood and smoked ten cigarettes a day. He denied any use of alcohol or illicit drugs. He had recently returned from a trip to Thailand ten days ago.

During the examination, the patient appeared tall and thin with no signs of clubbing or lymphadenopathy. He did not show any signs of cyanosis, but had a resting tachycardia and an audible click during expiration. What is the most likely underlying diagnosis?