Archives: MRCP Part 2

MRCP2-3841

A 49-year-old man with chronic kidney disease due to adult polycystic kidney disease presents with a three-month history of increasing fatigue and lethargy. He complains of feeling tired all the time and experiences mild shortness of breath when climbing stairs. However, he denies any dizziness and has walked from the parking lot to the clinic without any difficulty. Upon examination, he appears pale, and his flanks are full due to bilateral ballotable kidneys. He has a maturing arteriovenous fistula in his left arm that has not been used yet.

The following are his blood test results:

Hemoglobin (Hb): 80 g/l
Platelets: 125 * 109/l
White blood cells (WBC): 4.4 * 109/l

Sodium (Na+): 135 mmol/l
Potassium (K+): 4.8 mmol/l
Urea: 12.2 mmol/l
Creatinine: 265 µmol/l
Estimated glomerular filtration rate (eGFR): 15 ml/min

Ferritin: 102 ng/ml
Transferrin saturation: 23%

What is the most effective approach to managing this patient’s anemia?

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?

MRCP2-3843

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?

MRCP2-3844

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?

MRCP2-3845

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?

MRCP2-3846

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?

MRCP2-3847

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?

MRCP2-3848

A 65-year-old male patient arrives at the Emergency department with a general feeling of unwellness. Upon reviewing his medication list, you notice that he is taking acetazolamide, a carbonic anhydrase inhibitor. A blood gas analysis is performed. What acid/base imbalance can acetazolamide potentially induce?

MRCP2-3849

A 50-year-old man presents with severe left loin pain that radiates to his groin in spasms. He has a history of Crohn’s disease and had a small bowel resection with a jejunocolic anastomosis. Despite being on steroids, his Crohn’s disease has been quiescent for the past year. He has a normal bowel habit and eats a high-fiber diet while drinking 3 liters of fluid per day. On examination, he is tender in the left loin and has a blood pressure of 180/70 mmHg. Urinalysis shows +++ blood with no protein or nitrates and a urine pH of 5.5. A plain KUB x-ray reveals a radio-opaque area over the left ureter, and an IVU confirms the presence of a small calculi. What is the most likely cause of his renal stone?

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?