Archives: MRCP Part 2

MRCP2-4032

An 80 year-old man visited his GP complaining of swelling in his lower limbs that had developed over the past week. He also reported having frothy urine. The patient had a history of lung cancer and was about to start palliative chemotherapy. On examination, his blood pressure was 150/90 mmHg and his pulse was 88 beats per minute. Urinalysis showed 4+ protein and 1+ blood. The patient’s lab results revealed a hemoglobin level of 110 g/l, platelets of 375 * 109/l, and a WBC count of 4.9 * 109/l. His sodium level was 136 mmol/l, potassium was 4.6 mmol/l, urea was 23.0 mmol/l, creatinine was 420 µmol/l, serum albumin was 18 g/L, and his 24-hour urine protein was 4.5 g (<0.2). What is the most likely diagnosis?

MRCP2-4031

A 47-year-old woman has been hospitalized for the last 12 days to treat bronchopneumonia. She has recently experienced chills, fever, and a skin rash over the past 48 hours. A peripheral blood film shows eosinophilia, and her urinalysis indicates ++ proteinuria. She has no prior history of renal disease, and her HbA1c is within normal range. Based on these results, what diagnosis is most likely?

MRCP2-4030

You are presented with a 43-year-old female patient who has been admitted with dehydration and a history of borderline personality disorder, alcohol excess, and three previous upper gastrointestinal bleeds requiring endoscopic intervention. She is currently taking lithium MR 400 mg once daily, omeprazole 40 mg once daily, and thiamine 100 mg twice daily. Upon admission, her renal function and osmolalities were as follows: Na 155 mmol/L, K 4.9 mmol/L, urea 13.0 mmol/L, and creatinine 251 µmol/L. Her plasma osmolality was 329 mmol/kg (275-295 mmol/kg), and urine osmolality was 56 mmol/kg (500-800 mmol/kg). Despite receiving 5% glucose infusions, her renal function has not improved significantly. A water deprivation test with desmopressin was performed, and the pre- and post-desmopressin urine osmolalities were 64 mmol/kg and 72 mmol/kg, respectively. What is the most appropriate treatment for this patient’s likely diagnosis?

MRCP2-4026

A 31-year-old man presented to his GP with complaints of persistent headaches and nasal congestion for the past 4 weeks. Despite taking over-the-counter decongestants and flu remedies, his symptoms did not improve. He also experienced recurrent nosebleeds and coughed up fresh blood a few times. Additionally, he had been having night sweats. The patient had no prior medical history and was not taking any regular medications.

The GP was concerned about the patient’s symptoms and ordered some blood tests. The results showed a low haemoglobin level, high potassium level, and elevated creatinine level. The GP admitted the patient to the hospital to investigate the cause of the high creatinine level. Further tests revealed protein and blood in the urine, as well as multiple, well-defined lesions in both lung fields on a chest X-ray. The patient tested positive for c-ANCA with high PR3 titres and negative for p-ANCA and Anti-GBM antibodies. Complement levels were normal.

Based on the patient’s presentation, what type of glomerulonephritis (GN) would be expected on a renal biopsy?

MRCP2-4016

A 50-year-old male of African–Caribbean descent presented to the emergency department complaining of leg swelling, shortness of breath, and nausea that had been progressively worsening over the past 6 weeks. He had recently relocated to the UK from South Africa about 3 months ago. The patient had a history of mild peripheral vascular disease and was taking atorvastatin and clopidogrel.

Upon examination, the patient was comfortable at rest but had significant pitting edema in both lower limbs and bilateral dullness to percussion at the lung bases. His blood pressure was 181/101 mmHg.

The urine dipstick showed 2+ blood and 4+ protein. Blood test results revealed a urea level of 21 mmol/L (2.0 – 7.0), creatinine level of 256 µmol/L (55 – 120), and albumin level of 24 g/L (35 – 50). The 24-hour urine protein measurement was 8g/day.

Further blood tests were conducted, including ANA, ANCA, complement (C3 and C4), hepatitis serology, HIV screening serology, and serum protein electrophoresis, which all came back negative. A renal ultrasound was performed, which showed an increased echogenicity bilaterally but no hydronephrosis. Peak flow velocities were normal and equal bilaterally. A renal biopsy was also performed, revealing segmental areas of scarring affecting some of the glomeruli, with no hypercellularity or crescents visible.

What is the appropriate management plan for this patient, given the likely diagnosis?

MRCP2-4006

A 65-year-old man presents with hypertension at 170/95 mmHg and deteriorating kidney function. He has a history of a previous transient ischemic attack and is a heavy smoker, consuming 20 cigarettes per day. Imaging studies reveal stenosis of the right renal artery. Can you estimate the five-year survival rate for patients with this condition?

MRCP2-4015

A 54-year-old man presents to the hospital with symptoms of dysuria and frequency. He reports experiencing two episodes of visible haematuria and occasional loin pain with radiation into his flank. The patient has a medical history of hypertension and recurrent urinary tract infections. He also mentions having multiple renal stones in the past but has never seen a urologist. His current medications include candesartan in the morning and cefalexin at night. Relevant investigations reveal a mildly radio-opaque density at the level of the right renal pelvis on abdominal x-ray, and a high urinary ammonia level with a urinary pH of 7.32. What type of renal stone is likely responsible for these findings?

MRCP2-4001

A 33 year-old man came to his GP complaining of dark coloured urine. He had a sore throat two weeks ago but didn’t seek medical attention. He had no significant medical or family history.

During the examination, his pulse was recorded at 60 beats per minute and his blood pressure was 160/95 mmHg. There were no notable findings during abdominal examination. Urinalysis revealed 3+ blood and 1+ protein.

What is the primary diagnostic test that needs to be conducted?

MRCP2-4004

A 60-year-old woman with end-stage renal disease received a renal transplant six months ago. Her baseline creatinine is 130 µmol/L. During physical examination, her blood pressure is 170/80 mmHg and she experiences discomfort in her transplant kidney area. Her blood test results show urea 25 mmol/l, creatinine 550 µmol/l. What is the most probable renal pathology to reoccur in a patient who has undergone a renal transplant?

MRCP2-4003

A 35-year-old teacher presents to her primary care physician (PCP) with a 4-week history of increasing leg swelling. The rest of the medical history is unremarkable and she is not taking any medications. Upon examination, pitting edema is noted in the legs. Her blood pressure is 120/70 mmHg with no orthostatic changes. The following blood results are obtained (the sample was noted to be lipemic):

Sodium (Na+): 125 mmol/L (normal range: 135-145 mmol/L)
Potassium (K+): 4.2 mmol/L (normal range: 3.5-5.0 mmol/L)
Urea: 5.0 mmol/L (normal range: 2.5-6.5 mmol/L)
Creatinine (Cr): 80 µmol/L (normal range: 50-120 µmol/L)
Albumin: 20 g/L (normal range: 35-55 g/L)
Glucose: 4.8 mmol/L (normal range: 3.5-5.5 mmol/L)
Plasma osmolality: 280 mOsmol/kg
24-hour urinary protein: 5.8 g

What additional test would be helpful in determining the cause of this patient’s hyponatremia?