Archives: MRCP Part 2

MRCP2-4198

A 57-year-old man with severe asthma presents with two days of shortness of breath and tightness in his chest. He has a history of multiple exacerbations and was intubated four months ago for a severe exacerbation. He is currently taking montelukast, beclometasone and salbutamol.

Upon arrival, he is cyanosed and his oxygen saturation is at 92% in air. He is using accessory muscles and is unable to speak beyond groans. His respiratory rate is 22/min and there is a quiet wheeze heard bilaterally in his chest. Despite nebulisers, steroids and magnesium sulfate, he has not responded. He is scheduled for intubation and the initiation of aminophylline.

What is the essential recording to make when administering aminophylline?

MRCP2-4200

A 79-year-old man was admitted to the hospital from a residential home due to chest pain. He had a history of ischaemic heart disease and had suffered a myocardial infarction eight years ago. His congestive cardiac failure was well controlled with medication. The only other notable event in his past was a chest injury sustained during his time in the armed services sixty years ago when he was hit by shrapnel while serving in North Africa. He was born and raised in India but had lived in the United Kingdom for his entire adult life, working as a secondary school teacher and later as a headmaster of a boys’ boarding school. His ECG showed lateral ST segment elevation and his serum troponin T was elevated. The chest x-ray revealed pleural calcification at the right base. What is the most likely cause of pleural calcification in this patient?

MRCP2-4199

A 23-year-old female patient complains of repeated episodes of breathlessness and cough with foul-smelling sputum. She has a medical history of recurrent colicky abdominal pain over the past four years. Upon investigation, sputum culture reveals a significant growth of Pseudomonas aeruginosa and Haemophilus influenzae. Additionally, her chest X-ray shows tramline and ring shadows. What is the probable cause of her symptoms?

MRCP2-4192

A 54-year-old man presents to the emergency department with complaints of shortness of breath. He recently flew back from Australia and has a medical history of type two diabetes mellitus, high cholesterol, hypertension, and a previous cholecystectomy. He is also morbidly obese. The patient denies any chest pain or leg pain or swelling. His vital signs are stable, and an ECG shows sinus rhythm. A chest X-ray is normal. A CT pulmonary angiogram (CTPA) is performed to rule out pulmonary embolism (PE), which is negative. However, the CTPA reveals a 7mm pulmonary nodule in the left lower lobe. What is the appropriate course of action for investigating or monitoring the pulmonary nodule?

MRCP2-4189

A 50-year-old woman presented to the outpatient clinic with a complaint of cough and shortness of breath that had been going on for four weeks. She reported producing 500 ml of frothy mucoid sputum per day due to the severity of her cough. Although she had noticed a decrease in appetite, she had not experienced any weight loss. What is the probable diagnosis?

MRCP2-4187

A 56-year-old man has been experiencing increasing shortness of breath and orthopnoea over the past few years. He finally went to his GP after a severe episode of breathlessness while wading in the sea on holiday. He also reported morning headaches and an increasing tendency to fall asleep during the day. On examination, reduced breath sounds and percussion note bi-basally were noted. What is the most probable diagnosis based on the given information and test results?

MRCP2-4190

A 25-year-old male patient arrives at the Emergency department with a severe asthma exacerbation. The medical team administers nebulised salbutamol and ipratropium bromide along with 15 L oxygen. The patient’s pre-treatment and post-treatment results are as follows: PO2 (kPa) 6.6 and 7.9, PCO2 (kPa) 3.4 and 3.5, pH 7.35 and 7.32, and PEFR (L/min) 100 and 160. Based on BTS guidelines, what is the next step in managing this patient’s asthma exacerbation?

MRCP2-4186

A 25-year-old female presents to the Emergency Department with complaints of pleuritic chest pain and exertional dyspnea. There is no history of trauma. Upon examination, a standard erect PA chest radiograph reveals a 4 cm apical pneumothorax. The chest physician determines that a chest drain is necessary and should be inserted promptly. What is the most suitable technique for this procedure?

MRCP2-4188

A 54-year-old carpenter presents with breathlessness and a persistent cough. He has a history of chronic obstructive pulmonary disease and ulcerative colitis, and he smokes up to 20 cigarettes a day. The cough produces clear sputum up to 500 ml per day, but there is no haemoptysis. His exercise tolerance is now limited to 50 metres due to the breathlessness, and he has lost over 2 stone in the past two months. On examination, there is dullness to percussion at the left lung base, and his abdomen is tender but not guarding.

What is the most likely diagnosis?

MRCP2-4196

A 67-year-old man is brought to the hospital after being found unconscious in his home. He is drowsy but can be awakened and complains of a severe headache and nausea.

On examination, his temperature is 36.5°C, but he appears flushed. His neck is supple, and there is no palpable lymphadenopathy. His blood pressure is 110/65 mmHg, and his heart sounds normal with no murmurs or added sounds. His chest is clear to auscultation, and the rest of the examination is unremarkable.

His daughter reported that her father, usually a skilled woodworker, had appeared clumsy lately and had been confused at times when talking on the telephone.

Investigations show:

– Haemoglobin 158 g/L (130-180)
– White cell count 10.1 ×109/L (4-11)
– Platelets 401 ×109/L (150-400)
– Serum sodium 140 mmol/L (137-144)
– Serum potassium 4.4 mmol/L (3.5-4.9)
– Serum urea 5.8 mmol/L (2.5-7.5)
– Serum creatinine 110 µmol/L (60-110)
– Serum glucose 4.5 mmol/L (3.0-6.0)
– CSF opening pressure 150 mmH2O (50-180)
– CSF cell count <3 mL-1 (≤5)
– CSF protein 0.4 g/L (0.15-0.45)
– CSF glucose 3.3 mmol/L (3.3-4.4)
– Arterial blood gases breathing air:
– PaO2 11.6 kPa (11.3-12.6)
– PaCO2 4.3 kPa (4.7-6.0)
– HCO3 20 mmol/L (20-28)
– pH 7.33 (7.36-7.44)

Based on the information available, what investigation would you like to perform?