Archives: MRCP Part 2

MRCP2-3844

A 63-year-old man, who has been undergoing long-term haemodialysis for end-stage kidney disease due to type 1 diabetes, presents to the clinic with complaints of pain and tingling in his hands, particularly in the early hours of the morning. He also experiences difficulty with dysphagia and indigestion, and an echocardiogram performed for decreased LV function revealed a suspicion of early constrictive pericarditis. During further questioning, he admits to drinking a glass of whisky each evening. On examination, there is weakness of thumb abduction, apposition, and flexion, and some sensory loss is suspected. Based on the investigations provided, what is the most likely cause of his upper limb neurological symptoms?

MRCP2-3836

A 29-year-old man with a family history of autosomal dominant polycystic kidney disease presented to renal clinic for evaluation. His mother and two older siblings have previously been diagnosed with the disease. Although he had been asymptomatic, the patient was now eager to undergo investigation and treatment. He had no prior medical history and did not take any regular medications.

During clinical examination, the patient had a euvolaemic fluid status, and his abdomen showed no abnormalities. His blood pressure was measured at 132/82 mmHg.

The following investigations were conducted after clinic assessment:

– Urea: 6.7 mmol/L
– Creatinine: 85 micromol/L
– Estimated globular filtration rate: >90 mL/min/1.73 m3
– Sodium: 140 mmol/L
– Potassium: 3.9 mmol/L

Renal tract ultrasound revealed that the left kidney was 10 cm in length with three cysts, and the right kidney was 9.7 cm in length with two cysts. There were no renal or ureteric calculi, hydronephrosis, or hydroureter. The urine dipstick showed proteinuria ++, but was otherwise unremarkable.

What is the appropriate therapeutic management for this patient at this time?

MRCP2-3845

A 65-year-old man with hypertension and chronic kidney disease comes for his annual check-up at the nephrology clinic. His recent urine test shows an albumin:creatinine ratio (ACR) of 75 mg/mmol. His blood work reveals:
– Sodium: 139 mmol/L (137-144)
– Potassium: 4.1 mmol/L (3.5-4.9)
– Urea: 9.8 mmol/L (2.5-7.5)
– Creatinine: 98 μmol/L (60-110)
(eGFR 52 ml/min/1.73 m2).
What is the appropriate target range for his blood pressure?

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?

MRCP2-3850

A 57-year-old woman is admitted to the ward with symptoms of sore throat, joint pains, shivering attacks, and rash. She has been taking lithium for bipolar disorder for the past two years. Her blood tests show low haemoglobin, high white cell count, high platelets, high urea, high creatinine, and eosinophils and red blood cells in her urine. What is the most probable diagnosis?

MRCP2-3847

A 65 year old female with end-stage renal failure presents to the medical assessment unit with painful legs. She has a medical history of atrial fibrillation, rheumatoid arthritis, and osteoporosis. During examination, three painful, necrotic skin lesions are found on her left calf. There is minimal erythema surrounding the lesions, and her foot appears to be well-perfused with present peripheral pulses. Blood tests reveal an adjusted calcium level of 2.62 mmol/l and a parathyroid hormone level of 47 pmol/l. Which of her regular medications is contributing to her acute presentation?

MRCP2-3842

A 56-year-old woman has been admitted to the hospital with concerns of possible lupus nephritis after recent blood tests showed an acute kidney injury. Her medical history includes systemic lupus erythematosus (SLE), two prior transient ischaemic attacks, hypertension, and obesity. She regularly takes hydroxychloroquine, clopidogrel, and ramipril.

The renal team plans to perform a renal biopsy to investigate the presence of lupus nephritis and has requested an ultrasound before the procedure.

Renal Ultrasound: The right renal pelvis appears dilated, raising concerns for hydronephrosis. There is no visible obstruction or underlying collection. Both kidneys appear atrophic.

What is an absolute contraindication to the procedure?

MRCP2-3846

A 72-year-old patient with end-stage renal failure secondary to adult polycystic kidney disease presents with new painful necrotic skin lesions. Her general practitioner has referred her to hospital as they have failed to improve with oral antibiotics.

Upon examination, a bruit and thrill were noted over a left brachiocephalic fistula. The patient has an irregular 8cm x 4 cm, punched-out ulcer on the medial aspect of her left calf just below her knee. The centre of the ulcer is black and necrotic, with minimal surrounding erythema. She is afebrile.

Blood tests reveal a white cell count of 10.0 * 109/l and a C-reactive protein (CRP) level of 17 mg/dL. What diagnostic test should be performed to confirm the diagnosis?

MRCP2-3843

A 70-year-old man presents to his GP for a routine check-up and is found to have 3+ proteinuria on dipstick testing. He has a history of hypertension and has been taking ramipril 10 mg daily. He reports feeling unwell for the past few months and complains of back pain. On examination, his blood pressure is 148/90 mmHg and his pulse is 67 and regular.

The following investigations were conducted:
– Haemoglobin: 108 g/L (135-177)
– White cell count: 8.6 ×109/L (4-11)
– Platelets: 162 ×109/L (150-400)
– Serum sodium: 138 mmol/L (135-146)
– Serum potassium: 5.2 mmol/L (3.5-5)
– Creatinine: 135 μmol/L (79-118)
– Albumin: 24 g/L (35-50)
– Total protein: 60 g/L (62-77)
– Urinary protein: 2.2 g/24hrs

Which of the following factors is most closely associated with his prognosis?

MRCP2-3853

A 65-year-old woman presented to the rheumatology clinic for follow-up of her rheumatoid arthritis. Upon examination, she displayed symptoms and signs of active synovitis with elevated inflammatory markers. She had been receiving IM sodium aurothiomalate 50 mg once a week for the past six months and had recently completed a course of diclofenac 50 mg three times a day. Laboratory tests revealed a serum sodium level of 138 mmol/L (137-144), serum potassium level of 4.9 mmol/L (3.5-4.9), serum urea level of 12 mmol/L (2.5-7.5), and serum creatinine level of 290 µmol/L (60-110). A urine dipstick test showed protein and blood levels of ++, while a 24-hour urine collection revealed a protein level of 0.4 g/24hr (<0.2). Her renal function had been normal during her last clinic visit two months prior. What is the most likely cause of the decline in renal function?