Archives: MRCP Part 2

MRCP2-4146

A 67-year-old woman slips on an icy road and sustains a neck of femur fracture. She has a medical history of hypertension, type 2 diabetes, and a 40-year pack-year smoking history. After being hospitalized for six days, she experiences shortness of breath and haemoptysis. Her vital signs are as follows:

– Blood pressure: 135/70 mmHg
– Pulse: 110 bpm
– Temperature: 36.4 deg C
– Respiratory rate: 24/min
– Oxygen saturation: 89% on air

A subsequent CTPA reveals a right segmental pulmonary embolus and a 4mm solid nodule in her right upper lobe. What is the most appropriate approach to managing her nodule?

MRCP2-4144

A 67-year-old man who is visiting from Chile presents to the emergency department with worsening shortness of breath over the past two days. He has a history of rheumatoid arthritis, hypertension, and ischemic heart disease. He used to work in coal and silica extraction but retired due to health issues. He has lost 5 stone in weight over the past year and has a productive cough with black sputum, which he reports as normal for him. On examination, he is in respiratory distress with use of accessory muscles, has crepitations throughout the mid and upper zones, and is drowsy with peripheral cyanosis. His ABG shows a pH of 7.31, PaO2 of 7.92 kPa, and PaCO2 of 6.44 kPa. His chest X-ray shows upper zone reticulonodular changes with a large cavity on the right apex, and a high-resolution CT scan shows ground glass opacities in the upper zones with a modular appearance and centroacinar emphysema in the lower zone. His blood work shows a Hb of 110 g/l, platelets of 310* 109/l, WBC of 12.3 * 109/l, and CRP of 156 mg/l. What is the likely diagnosis?

MRCP2-4141

An 80-year-old man arrives at the acute medical unit complaining of intense back pain that started suddenly and reached its peak within seconds. Upon investigation, the chest x-ray shows blunting of the left costophrenic angle, and the pleural sample appears bloody. What is the most effective marker in the pleural fluid to diagnose a haemothorax?

MRCP2-4145

What is the most appropriate course of action for the continued treatment of this patient?

MRCP2-4151

A 75-year-old patient presents with exertional dyspnoea and bilateral pulmonary oedema on chest x-ray. The patient has a past medical history of type 2 diabetes mellitus, hypertension, hypercholesterolaemia, and a previous NSTEMI in 2010. An echocardiogram shows moderate to severe LV dysfunction and a pulmonary arterial pressure of 83 mmHg (normal <25 mmHg). What diagnostic investigation should be done next?

MRCP2-4153

A 20-year-old woman presents with increasing breathlessness and hypoxia two days after being admitted for severe burns. She has no significant medical history, but her father had a heart attack at age 40. She is a non-smoker and has a respiratory rate of 26 breaths per minute and a pulse rate of 110 beats per minute. Crackles are heard over both lung fields on examination, and a chest x-ray shows bilateral hazy shadowing. What is the probable diagnosis?

MRCP2-4149

A 58-year-old man was admitted to the hospital with a productive cough. Chest x-ray revealed left basal pneumonia. He was treated with intravenous antibiotics and discharged after successful weaning off oxygen. What follow-up, if any, should be recommended for this patient?

MRCP2-4152

A 23-year-old man presents to the emergency department with a worsening cough and shortness of breath over the past few days. He has no significant past medical history except for a known allergy to bee stings and is not on any regular medication. Although he does not smoke himself, he works in an environment where others are often smoking around him.

Upon examination, he appears to be in respiratory distress, with tachypnoea, tachycardia and low-grade pyrexia. His peripheral oxygen saturations are 87% on air. Blood tests are conducted:

Hb 112 g/L Male: (135-180)
Female: (115 – 160)
Platelets 185 * 109/L (150 – 400)
WBC 13.3 * 109/L (22% eosinophils) (4.0 – 11.0)
Urea 6.9 mmol/L (2.0 – 7.0)
Creatinine 87 µmol/L (55 – 120)

A chest X-ray is also performed, which reveals patchy mixed alveolar-interstitial infiltrates. The medical team is consulted to review the patient, and a bronchoalveolar lavage is conducted, which shows no signs of infection but 56% eosinophils.

What is the most appropriate initial intervention given the likely diagnosis?

MRCP2-4148

A 50-year-old man presents to the Emergency Department with sudden onset chest pain and associated shortness of breath. The chest pain is on the left hand side only and there is no history of cough, fever chills or recent fatigue. The patient is an ex-smoker and has a background of well-controlled chronic obstructive pulmonary disease (COPD).

On examination the patient is tachycardia and tachypnoeic but otherwise the examination is normal.

Routine haematology and biochemistry are unremarkable but a chest x-ray shows a left sided pneumothorax which is measured to be approximately 2.5 cms.

What is the best management option for this patient?

MRCP2-4147

A 22-year-old woman presents to her family doctor with recurring episodes of shortness of breath and a dry cough. She has a history of asthma and is currently on treatment with Seretide 25/100 (salmeterol and fluticasone) using a metered dose inhaler with a spacer, which provides relief for most of the day. However, she experiences wheezing and breathlessness while running or cycling. She also has a medical history of allergic rhinitis and takes loratadine and various nasal sprays for it.

During the examination, the chest appeared normal, and peak expiratory flow readings were 78% predicted.

What would be the most appropriate course of action in this scenario?