Archives: MRCP Part 2

MRCP2-3905

A 22-year-old woman goes to a party with some friends to celebrate the end of the semester. The next day, she visits the Emergency department feeling sick. She experiences shortness of breath, nausea, and has excessive diarrhea. She consumed some alcohol at the party and took 1 g paracetamol before going to the emergency department, but it didn’t help much. Her blood test results show low hemoglobin, low platelets, high urea, high creatinine, and low bicarbonate levels. Her blood film shows fragmented cells. What is the most probable diagnosis?

MRCP2-3906

A 25-year-old female presents to the outpatient clinic with a history of Henoch-Schönlein purpura for the past six weeks. On examination, she has a non-blanching maculopapular rash on her back, buttocks, and lower legs, and her blood pressure is measured at 158/90 mmHg. Her serum urea is 8 mmol/L (2.5-7.5), serum creatinine is 118 µmol/L (60-110), and serum albumin is 30 g/L (37-49). Urinalysis shows protein 0 and blood +. What is the most appropriate treatment for this patient?

MRCP2-3907

A 45-year-old man presents to the emergency department with bilateral leg swelling. He has a medical history of hepatitis B, hepatitis C, type 2 diabetes, and previous syphilis. He is currently using intravenous heroin.

Upon examination, there is peripheral edema extending to his upper thighs. Chest auscultation is normal, and the jugular venous pulse is not raised. There is no clinical evidence of decompensated liver disease.

Blood tests reveal a hemoglobin level of 138 g/L, platelets at 189 * 109/L, and a white blood cell count of 4.2 * 109/L. His sodium and potassium levels are within normal range, as is his urea and creatinine. His CRP is 4 mg/L, bilirubin is 12 µmol/L, ALP is 88 u/L, ALT is 32 u/L, γGT is 44 u/L, and albumin is 20 g/L. However, his urine protein:creatinine ratio is 425 mg/mmol, which is significantly higher than the normal range of <50. A renal biopsy is performed, which reveals focal and segmental sclerosis and hyalinosis on light microscopy. What is the likely underlying cause for this diagnosis?

MRCP2-3908

A 60-year-old man with chronic renal disease is being evaluated for renal transplantation. During his counselling, he is informed that immunosuppression after the transplant can increase his chances of developing cancer. Which type of cancer has the highest risk of occurrence due to immunosuppression?

MRCP2-3909

A 50-year-old man with a history of HIV presents at the clinic with complaints of bilateral ankle swelling that has been progressively worsening over the past few months. Upon examination, he has a BMI of 21 and a BP of 122/72 mmHg, with bilateral pitting oedema of both legs. Laboratory investigations reveal a haemoglobin level of 118 g/L (135-177), a white cell count of 8.6 ×109/L (4-11), platelets of 192 ×109/L (150-400), serum sodium of 139 mmol/L (135-146), serum potassium of 4.8 mmol/L (3.5-5), creatinine of 172 µmol/L (79-118), albumin of 28 g/L (35-50), and urinary protein of 3.7 g/24hrs. A renal ultrasound scan shows normal sized kidneys, and a renal biopsy confirms focal segmental glomerulosclerosis. What is the most likely diagnosis for this patient?

MRCP2-3910

A 36-year-old man of African descent presented to the HIV clinic for a routine check-up. He had been on HAART for 4 years but admitted to frequently forgetting to take his medication.

During the examination, the patient was found to have pitting edema in both ankles. A urinalysis performed in the clinic showed 4+ protein and 1+ blood.

Further blood tests revealed a CD4 count of 130 cells/mm3 (normal range: 500-1500) and normal serum complement levels. A renal biopsy was performed, which showed collapsing FSGS.

What is the most likely diagnosis for this patient?

MRCP2-3911

A 56-year-old woman with end stage renal failure due to hypertension presents with complaints of increasing fatigue and thirst. She is currently undergoing renal replacement therapy through haemodialysis and is taking Levemir, NovoRapid, ramipril, aspirin, simvastatin, calcium carbonate, and erythropoietin. On examination, her pulse rate is 84 beats per minute and regular, and her blood pressure is 138/65 mmHg. The jugular venous pressure is visible 2 cm above the clavicle (prior to dialysis), the lung bases are clear, and there is no peripheral oedema. A functioning radiocephalic arteriovenous fistula is present in her left arm.

Her pre-dialysis blood tests reveal a haemoglobin level of 105 g/L (115-165), sodium level of 134 mmol/L (137-144), potassium level of 4.7 mmol/L (3.5-4.9), urea level of 34 mmol/L (2.5-7.5), creatinine level of 437 μmol/L (60-110), corrected calcium level of 2.78 mmol/L (2.2-2.6), phosphate level of 1.79 mmol/L (0.8-1.4), and parathyroid hormone level of 724 ng/L (15-65).

What is the most likely diagnosis?

MRCP2-3912

A 57 year-old woman comes in for her annual diabetic check-up. She has been diagnosed with type 2 diabetes mellitus for 13 years and is currently only taking metformin for her diabetes. During her last diabetes check-up 1 week ago, her HbA1c was found to be 40 mmol/mol. She has a medical history of peripheral vascular disease and migraine. Additionally, she has a smoking history of 20 pack years and drinks 5-10 units of alcohol per week. Upon examination, her pulse rate is 86 beats per minute and her blood pressure is 126/70 mmHg. Blood tests reveal a sodium level of 140 mmol/l, potassium level of 3.4 mmol/l, urea level of 7.0 mmol/l, and creatinine level of 105 µmol/l. Urinalysis shows negative results for protein, glucose, leucocytes, and nitrites. However, a 24-hour urine sample indicates 190 mg of albumin in her urine.

What would be the most appropriate next step in managing her renal function?

MRCP2-3913

A 70-year-old Indian male presents with left loin pain and occasional frank haematuria. He reports the symptoms started 3 months ago during a visit to Mumbai but have been getting progressively worse over the past 5 days. He also reports gradual weight loss and reduced appetite as well as a non-productive cough.

His past medical history includes type 2 diabetes mellitus, hypertension and hypercholesterolaemia. On examination, his temperature is 37.8 degrees and he is haemodynamically stable.

Abdominal examination reveals a significant swelling in his left scrotum, which does not empty on lying flat. The abdomen is otherwise soft and bowel sounds are present are normal. Lastly, bilateral lower limb swelling is noted to the top of both thighs. A urine dip reveals pH 6.5 4+ blood 1+ protein 1+ leucocyte 1+ nitrite. An initial chest radiograph reveals multiple round opacities in both lung fields. Blood tests are awaited.

Which diagnostic test is most likely to uncover the underlying condition?

MRCP2-3914

A 54-year-old man presents to the Emergency Department referred by his General Practitioner due to abnormal renal profile results. The patient’s laboratory results show Na+ 140 mmol/l, K+ 3.4 mmol/l, Urea 25.2 mmol/l, and Creatinine 380 µmol/l. The patient has a medical history of neurofibromatosis type 1, hypertension, and type 2 diabetes mellitus. Despite controlling hypertension and diabetes with diet alone, the patient started taking amlodipine, irbesartan, and metformin two weeks ago. Urinalysis is negative for blood, protein, and nitrites. What is the most likely diagnosis?