Archives: MRCP Part 2

MRCP2-3967

A 47-year-old woman with a 15-year history of bipolar disease presents to the endocrine clinic for evaluation. She is currently taking lithium and olanzapine, and has been experiencing increasing polyuria and polydipsia over the past few months. Additionally, she has gained 6 kg since starting olanzapine.

During the examination, her blood pressure is 132/88, pulse is regular at 78 beats per minute, and there is a 10 mmHg drop in blood pressure upon standing. There are no murmurs and her chest is clear. She has a BMI of 32 and is considered obese.

The following investigations were conducted:
– Hb: 115 g/l (normal range: 115-160)
– WCC: 5.1×10(9)/l (normal range: 3.8-10.8)
– PLT: 191×10(9)/l (normal range: 150-450)
– Na: 145 mmol/l (normal range: 135-145)
– K: 4.9 mmol/l (normal range: 3.5-5.5)
– Bicarbonate: 25 mmol/l (normal range: 18-28)
– Cr: 115 micromol/l (normal range: 50-90)
– Glucose: 7.1 mmol/l (normal range: <7) After a water deprivation test, the following results were obtained:
– Serum osmolality: 320
– Urine osmolality: 285 (no significant change after DDAVP)

What is the most likely cause of the patient’s clinical presentation?

MRCP2-3968

A 57-year-old man presents to the renal clinic for a follow-up of his stable stage 4 CKD, which is caused by hypertensive nephrosclerosis. During his visit, his blood work is taken and the results are phoned to the ward. The results are as follows:

Sodium: 138 mmol/L (137-144)
Potassium: 4.2 mmol/L (3.5-4.9)
Creatinine: 310 μmol/L (stable) (60-110)
Corr calcium: 1.86 mmol/L (2.2-2.6)
Phosphate: 1.24 mmol/L (0.8-1.4)
PTH: low

Which medication is the probable culprit for his condition?

MRCP2-3969

A 65-year-old male presents to the Emergency department with worsening shortness of breath. He has been experiencing this for the past two weeks and has also noticed swelling and discomfort in his legs. The patient has a medical history of ischemic heart disease with congestive heart failure, gout, and gastroesophageal reflux. He is currently taking several medications including omeprazole, allopurinol, atorvastatin, digoxin, furosemide, spironolactone, carvedilol, ramipril, and trimethoprim for a urinary tract infection.

Upon examination, the patient is slightly short of breath at rest with a blood pressure of 108/80 mmHg. His jugular venous pressure is elevated, and he has peripheral edema up to his knees. Auscultation of the heart reveals a soft systolic murmur at the apex, and he has bilateral basal chest crackles.

Laboratory investigations reveal abnormal levels of serum sodium, potassium, urea, creatinine, and plasma glucose. The patient’s serum creatinine level is 400 µmol/L, which is significantly higher than the normal range of 60-110 µmol/L.

Which medication can be continued without requiring a dose reduction due to the patient’s renal impairment?

MRCP2-3970

A 48-year-old male presents to the medical team after being referred by his GP in the urgent care centre. He reports experiencing non-specific symptoms for the past 6 months, including fatigue and malaise, with no specific focal symptoms. The patient also notes that his urine appears frothy, and a urine sample reveals 4+ protein and 4+ blood, but no leucocytes or nitrites. During examination, the patient’s resting blood pressure is found to be 190/120 mmHg, and bilateral periorbital oedema, a right varicocele, and prominent abdominal veins are noted. There is also significant swelling around both eyes. The patient has a history of intravenous drug use, one previous admission for cellulitis around a groin injection site, positive hepatitis B, and atopic dermatitis. He denies drug use over the past 2 months and any recent infections.

The patient’s initial serum results show Hb 105 g/l, platelets 426 * 109/l, WBC 11.2 * 109/l, Na+ 138 mmol/l, K+ 4.3 mmol/l, urea 16 mmol/l, creatinine 230 µmol/l, albumin 19 g/l, and CRP 16 mg/l. An urgent ultrasound of his renal tract reveals a right renal vein thrombus.

What is the most likely underlying diagnosis?

MRCP2-3971

A 65-year old man with a history of non-small cell lung cancer underwent a right lower lobectomy a year ago. Recently, he had a chest and abdominal CT scan which revealed hepatic mass lesions and hilar lymphadenopathy. He is currently experiencing malaise and fatigue. Upon examination, his urinalysis showed protein +++ and his 24-hour urine protein was 2.7 g/24hr. His serum urea was 30 mmol/L (2.5-7.5) and his serum creatinine was 450 µmol/L (60-110). A renal biopsy revealed focal deposition of IgG and C3 with a granular pattern. What is the most likely diagnosis?

MRCP2-3972

A 49-year-old man presents to the emergency department with bilateral lower limb swelling that has developed over the past week. He also reports having frothy urine. Upon examination, he has pitting edema up to his sacrum, a pulse of 65 beats per minute, and a blood pressure of 170/96 mmHg. Urinalysis reveals protein 4+. Blood tests show a hemoglobin level of 118 g/L, platelets of 482 * 109/L, and a white blood cell count of 8.5 * 109/L. His sodium level is 134 mmol/L, potassium is 3.6 mmol/L, bicarbonate is 23 mmol/L, urea is 4.5 mmol/L, and creatinine is 89 µmol/L. His bilirubin level is 6 µmol/L, ALP is 96 u/L, ALT is 34 u/L, γGT is 42 u/L, and albumin is 18 g/L. A renal biopsy shows diffuse thickening of the glomerular basement membrane with spikes on the surface of the capillary loops, and anti-PLA2R antibodies are negative. What is the recommended next step in investigations?

MRCP2-3976

You have been requested to examine a patient with the following blood results:
Sodium 141 mmol/L (137-144)
Potassium 4.2 mmol/L (3.5-4.9)
Creatinine 79 μmol/L (60-110)
cANCA positive
anti-PR3 4
anti-MPO >100
What is the probable diagnosis for this patient?

MRCP2-3977

A 19 year-old man presented to his physician complaining of facial puffiness and leg swelling that had developed over the past few weeks. He had no significant medical history and no family history of note. He was not taking any regular medications.

During the physical examination, his pulse was found to be 90 beats per minute and his blood pressure was 140/80 mmHg. Cardiovascular, respiratory and abdominal examination did not reveal any abnormalities. Urinalysis showed 4+ protein and 1+ blood, but was negative for glucose.

The following laboratory results were obtained:
– Hemoglobin: 138 g/l
– Platelets: 185 * 109/l
– White blood cells: 6.6 * 109/l
– Sodium: 144 mmol/l
– Potassium: 4.0 mmol/l
– Urea: 5.5 mmol/l
– Creatinine: 78 µmol/l
– Serum albumin: 20 g/L
– 24 hour urine protein: 5.1 g (<0.2) A renal biopsy was performed and showed podocyte fusion on electron microscopy. What is the most appropriate next step in the treatment of this patient?

MRCP2-3978

A 67-year-old woman presents to the hospital with transient dysphasia and left-sided weakness affecting her face and arm. She has a medical history of ischaemic heart disease, hypertension, and end-stage renal failure, and undergoes haemodialysis every Monday, Wednesday, and Friday mornings. A plain CT scan of the brain shows no evidence of an acute infarction or haemorrhage. Further brain imaging is requested by the consultant, and you are asked to coordinate with the radiology department. What statement applies to this patient?

MRCP2-3979

A 15-year-old female patient is referred to the hospital by her GP due to ankle and facial swelling, as well as dark urine that has been present for four days. She had visited the practice two weeks ago with pharyngitis. During examination, her blood pressure is found to be 165/100 mmHg, and her urine dipstick shows a strong positive for protein and blood.

Upon admission, the patient is diagnosed with acute kidney injury, with a creatinine level of 189 μmumol/l and urea level of 17.8 mmol/l. A renal ultrasound scan reveals normal sized kidneys with no signs of obstruction. After controlling her blood pressure, a renal biopsy is performed.

What are the expected histological features on light microscopy?