Archives: MRCP Part 2

MRCP2-4729

A 57-year-old woman presents to the blood pressure clinic with uncontrolled hypertension despite lifestyle modifications. She denies experiencing any headaches or vision changes, but reports a chronic cough and frequent pale, loose stools. She also mentions getting cold hands that turn red, white, and blue in the winter.

During the examination, you note that she is thin and has a blood pressure of 190/100 mmHg with a heart rate of 68 beats per minute. Her nails appear normal, but she has tight, shiny skin over her hands. An ECG shows sinus rhythm.

Lab results reveal a hemoglobin level of 106 g/l, platelet count of 451 * 109/l, WBC count of 8.9 * 109/l, sodium level of 136 mmol/l, potassium level of 4.9 mmol/l, urea level of 7.1 mmol/l, and creatinine level of 174 µmol/l.

What is the most appropriate initial therapy for this patient?

MRCP2-4731

A 55-year-old woman presents with a history of breathlessness on exertion, leg swelling, and a recent rash on her face. She was diagnosed with congestive heart failure and acute kidney injury and is currently being treated with diuretics. An echocardiogram revealed severe left ventricular dysfunction. During her hospitalization, she experienced a ventricular fibrillation cardiac arrest, which was successfully treated. She is now receiving amiodarone and betablocker. Her blood tests did not show any electrolyte abnormalities, and a coronary angiogram revealed normal coronary arteries. She was subsequently diagnosed with systemic lupus erythematosus and lupus myocarditis and is receiving appropriate immunosuppressive treatment. What is the best management for her ventricular fibrillation cardiac arrest?

MRCP2-4732

A 72-year-old woman presents with vision loss in her right eye, accompanied by pain while chewing and a persistent headache. Upon examination, her visual acuity is 6/60 in the affected eye, and ophthalmoscopy reveals a swollen, pale optic disc. Her blood work shows a low hemoglobin level of 115 g/L, high platelet count of 545 * 109/L, elevated white blood cell count of 11.1 * 109/L, and an elevated ESR of 45 mm/hour. Her HbA1c level is also high at 82 mmol/mol. She has a history of hypertension and diabetes mellitus, and has not been keeping up with retinal screening. What is the most likely cause of her vision loss?

MRCP2-4715

A 68-year-old man has been experiencing painful swelling in his right knee and difficulty walking for the past three days. He has also had two instances of severe pain and swelling in his right big toe within the last year. A knee aspiration revealed the presence of leukocytes but no organisms on Gram stain, as well as negatively birefringent crystals on polarised light microscopy. Recent blood tests showed normal renal function, but a raised serum urate level of 452 µmol/L (210-415 µmol/L). What is the next step in managing his condition in the long term, once the current episode of acute synovitis has subsided?

MRCP2-4716

A 75-year-old woman with rheumatoid arthritis comes in for her routine blood tests to monitor her methotrexate use. She takes methotrexate 15 mg once a week with folic acid 5mg once weekly on a different day. She reports feeling well and her arthritis is under control. She is a non-smoker and does not consume alcohol. The results of her blood tests are as follows:

Hemoglobin (Hb): 135 g/l
Platelets: 220 * 109/l
White blood cells (WBC): 6.5 * 109/l
Neutrophils (Neuts): 4.2 * 109/l
Sodium (Na+): 140 mmol/l
Potassium (K+): 4.0 mmol/l
Bilirubin: 12 µmol/l
Alkaline phosphatase (ALP): 95 u/l
Alanine transaminase (ALT): 75 u/l
Urea: 4.5 mmol/l
Creatinine: 90 µmol/l

What is the appropriate next step for this patient?

MRCP2-4717

A 35-year-old woman with systemic lupus erythematosus presents at the rheumatology clinic for her annual follow-up. Despite feeling well, routine blood tests reveal abnormal results, including elevated creatinine levels and significant protein and blood in her urine. After an ultrasound of her kidneys shows no abnormalities, the medical team recommends a kidney biopsy to investigate suspected lupus nephritis. Which class of lupus nephritis is associated with the poorest prognosis?

MRCP2-4718

A 60-year-old man with a history of Rheumatoid Arthritis and currently taking sulfasalazine is referred to the medical team by his GP due to severe and persistent flu-like symptoms and abnormal blood test results. Upon examination, his temperature is 38.3 degrees Celsius, heart rate is 104 beats per minute, respiratory rate is 31 breaths per minute, and oxygen saturation is 92% on room air. His blood test shows a hemoglobin level of 82 g/L, platelet count of 52 * 10^9/L, white blood cell count of 18 * 10^9/L, ferritin level of 50,000 ng/mL, and a positive EBV Monospot test.

Initially, he is treated for neutropenic sepsis with broad-spectrum antibiotics and is transferred to the intensive care unit for organ support. However, his condition does not improve, and he is subsequently evaluated by a hematologist who performs a bone marrow aspirate, revealing haemophagocytosis. What is the most probable underlying diagnosis?

MRCP2-4719

A 45-year-old woman presents to an outpatient rheumatology clinic with a history of Systemic lupus erythematosus for the past 5 years. She initially presented with fatigue, anaemia and a rash. Her medical history includes hypertension, gout and psoriasis. Despite noticing deformities in her hand joints, she denies any functional impairment or pain.

Upon examination, the patient exhibits marked reducible ulnar subluxation and deviation at the MCP joints, which is symmetrical. X-rays of her hands reveal no erosions.

What is the most likely diagnosis?

MRCP2-4720

A 30-year-old man presents to the emergency department with a fever, rash, and joint pain that has been occurring most evenings for the past two weeks. On examination, he has a maculopapular rash over his back and upper limbs, as well as pain and swelling in his wrists, knees, and ankles. Blood results show elevated WBC count, CRP, and ferritin levels. What is the most probable diagnosis?

MRCP2-4721

A 56-year-old woman comes to the clinic complaining of an itchy rash. She reports observing a bluish-purple patchy rash mainly on areas exposed to the sun. During the examination, she displays purple eyelids and rough raised purple patches on her knuckles. Her nails exhibit ragged cuticles, and blood vessels are visible on the nail fold. A poorly defined purple rash is present on both her arms extending up to her shoulders. What is the probable diagnosis?