Archives: MRCP Part 2

MRCP2-3867

A 25-year-old male presents to renal outpatients with his mother. The patient’s father, who has recently started haemodialysis, has been diagnosed with polycystic kidney disease. The patient’s paternal aunt has kidney disease and suffered a subarachnoid haemorrhage, while his paternal grandfather died of ‘kidney problems’ at the age of 64. On physical examination, his blood pressure is 129/64 mmHg and blood tests and urine dip are unremarkable. The patient and his mother are wondering if screening for polycystic kidney disease is appropriate. Which test should be offered to the patient?

MRCP2-3856

Which of the following conditions is unrelated to autosomal dominant polycystic kidney disease (ADPKD)?

MRCP2-3858

A 95-year-old woman is discovered on the floor of her apartment by her son. She was last seen three days ago and had complained of feeling unwell with a productive cough.
She is brought to the Emergency department, conscious and alert, for evaluation and treatment. Her vital signs are as follows: temperature 37.6°C, pulse 82, BP 110/70 mmHg, and oxygen saturation 89% on room air.
Upon physical examination, she appears mildly dehydrated and has crackles on the left base of her lung upon auscultation. A chest x-ray confirms a left lobar pneumonia with no significant signs of heart failure. An electrocardiogram is normal, and a renal ultrasound scan reveals no evidence of hydronephrosis with normal-sized kidneys. A urine dipstick test is positive for hematuria only.
Some of her initial laboratory results are as follows:
Hemoglobin 105 g/L (130-180)
White blood cell count 20 × 109/L (4-11)
Sodium 142 mmol/L (135-150)
Potassium 5.3 mmol/L (3.5-5.0)
Urea 16 mmol/L (2.5-7.5)
Creatinine on admission 230 µmol/L (60-110)
Creatinine two weeks ago 70 µmol/L (60-110)
Calcium (corrected) 2.2 mmol/L (2.2-2.6)
Phosphate 1.9 mmol/L (0.8-1.2)
She is started on intravenous fluid replacement and intravenous co-amoxiclav to treat community-acquired pneumonia. What is the next best blood test to determine the cause of her kidney dysfunction?

MRCP2-3865

A 68-year-old man visits his doctor with complaints of increasing difficulty in urination that has been worsening for several months. The doctor observes a decline in his kidney function and schedules a renal ultrasound scan, which reveals bilateral hydronephrosis. What is the probable diagnosis?

MRCP2-3855

A 42-year-old woman presents to the emergency department with a 2-day history of feeling generally unwell and nauseated. She is becoming increasingly drowsy and is unable to provide a coherent history.

Upon examination, she has a respiratory rate of 28 breaths/min and an oxygen saturation of 98% on air. Her heart rate is 100 beats/min with a blood pressure of 118/70 mmHg. She is not running a fever.

The arterial blood gas results are as follows:

– pH 7.25 (7.35 – 7.45)
– pO2 11.3 kPa (11 – 14.4)
– pCO2 4.7 kPa (4.6 – 6.4)
– Sodium 145 mmol/L (135 – 145)
– Potassium 5.0 mmol/L (3.5 – 5.5)
– Chloride 95 mmol/L (95 – 108)
– Bicarbonate 15 mmol/L (22 – 29)
– Glucose 6.9 mmol/L (4 – 7)
– Lactate 1.9 mmol/L (0.5 -2.2)
– Base excess -8 (-2 – 2)

What is the most probable cause of the above presentation?

MRCP2-3868

A 55-year-old woman presents with a two-day history of nausea and haemoptysis. She is feeling generally well, but has noticed that her urine appears pink. Upon urinalysis, ++++ blood and +++ protein are detected. A chest X-ray reveals diffuse bilateral infiltrates. Blood tests show elevated levels of sodium, potassium, urea, and creatinine. Which of the following is the most likely positive finding?

MRCP2-3854

A 65-year-old man with chronic kidney disease due to diabetes mellitus presents to the clinic. He reports no new symptoms and has well-controlled blood sugar levels.

He is currently taking metformin 1g twice daily, aspirin 75mg once daily, and bisoprolol 1.25mg once daily. During the examination, mild peripheral edema is noted, and his blood pressure is 135/80 mmHg, which has been confirmed by ambulatory blood pressure monitoring.

What would be the most appropriate course of action to take next?

MRCP2-3866

A 65-year-old woman presents with a four day history of nausea. She has no medication history and her only medical condition is diet controlled diabetes mellitus. Her recent checkup showed no signs of retinopathy or neuropathy, and her creatinine level was 79 µmol/L. Upon admission to the hospital, her blood tests reveal:
– Na 139 mmol/L (137-144)
– K 5.3 mmol/L (3.5-4.9)
– Urea 35.5 mmol/L (2.5-7.5)
– Creatinine 895 μmol/L (60-110)
– Hb 91 g/L (115-165)

Which of the following is most likely to be positive?

MRCP2-3869

A 25-year-old obese man presents with mild ankle swelling and a urinalysis that shows +++ protein but no blood. Upon further examination, he is diagnosed with nephrotic syndrome based on his cholesterol level of 6.9, albumin level of 30 g/dL, and proteinuria of 8 g/24 hours. He also has high blood pressure with a reading of 145/90 mmHg. A renal biopsy is scheduled for the following week, and a protein selectivity index of 15% is found in his urine analysis. He is started on prednisolone 60 mg daily as a precaution. Prior to the biopsy, his 24-hour urine collection is repeated and shows a decrease in urine protein output to 1.5 g/24 hours. What is the most likely diagnosis?

MRCP2-3870

A 21-year-old woman of African descent presents to your Nephrology Clinic with a complaint of dipstick-positive proteinuria and lower limb edema. She has no significant medical history and is not taking any regular medication. She reports occasional joint pain in her elbows and knees, which she manages with paracetamol. On examination, her blood pressure is 118/60 mmHg.

What is the most suitable test to determine the underlying diagnosis of this patient?