Archives: MRCP Part 2

MRCP2-3864

A 36-year-old man presents to the Endocrine Clinic after routine blood testing at the GP surgery. He has no significant previous medical history; his only recent attendance at the doctor’s was for a minor cold. There was no other past history of note and examination revealed blood pressure of 118/78 mmHg. No previous history of hypertension was noted.
Investigations:
Haemoglobin (Hb) 142 g/l 135 – 175 g/l
White cell count (WCC) 7 × 109/l 4.0 – 11.0 × 109/l
Platelets (PLT) 205 × 109/l 150 – 400 × 109/l
Sodium (Na+) 139 mmol/l 135 – 145 mmol/l
Potassium (K+) 2.8 mmol/l 3.5 – 5.0 mmol/l
Bicarbonate (HCO3-) 30 mmol/l 22 – 29 mmol/l
Creatinine (Cr) 95 μmol/l 50 – 120 µmol/l
Which of the following investigations would be most useful in pointing to the diagnosis?

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?

MRCP2-3866

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?

MRCP2-3867

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?

MRCP2-3868

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?

MRCP2-3869

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?

MRCP2-3839

A 59-year-old man presents with general lethargy and is currently undergoing treatment for bladder cancer complicated by paraneoplastic Guillain-Barré syndrome. Upon examination, there are no significant findings. However, his blood work reveals elevated levels of urea and creatinine, as well as a high CRP. An urgent KUB ultrasound is ordered and shows severe bilateral hydronephrosis. The urinalysis also indicates the presence of nitrites, leucocytes, blood, and protein. What is the most probable cause of his hydronephrosis?

MRCP2-3840

A 30 year old man has been admitted to an inpatient psychiatric hospital under section after experiencing a severe manic episode. He has a history of previous episodes of depression but has never been hospitalized for a mental health issue before. The patient has been started on treatment for bipolar affective disorder with lithium, lorazepam and olanzapine. During routine blood tests, the patient was found to be hyponatraemic and was observed to be passing large volumes of urine by ward staff. Basic investigations were requested following advice from the endocrine team.

Based on the provided laboratory results, what is the most likely cause of the patient’s polydipsia?

MRCP2-3851

A 70-year-old man with hypertension and type II diabetes mellitus managed with insulin on a basal-bolus regimen is admitted to the hospital with an acute, right-sided middle cerebral artery stroke. He is not thrombolysed due to hypertension and is transferred to the Stroke Ward for long-term management and rehabilitation. What is the probable underlying diagnosis based on his medical history and investigations?