Archives: MRCP Part 2

MRCP2-3834

A 65-year-old woman presented to the hospital with haematuria and other symptoms. She had been feeling unwell for a few weeks with vomiting, weight loss, fevers, and lethargy. The day before admission, she experienced haematuria with reduced urine output. She had no prior medical history but was an ex-smoker and worked as a retail shop manager. On examination, she appeared pale and lethargic with mild peripheral oedema. Her chest was clear, and her abdomen was soft and non-tender with no palpable masses.

The following investigations were conducted:

– Urine dip: blood+++, protein++
– Haemoglobin: 86 g/L
– White cell count: 8.7 x10^9/L
– Platelet Count: 201×10^9/L
– INR: 1.0
– Serum sodium: 139 mmol/L
– Serum potassium: 6.3mmol/L
– Serum urea: 34.0mmol/L
– Serum creatinine: 789 micromol/L
– CRP: 32
– Antinuclear antibody: negative
– Anti-neutrophil cytoplasmic antibody: negative
– Anti-glomerular basement membrane antibody: positive

Based on the results, she was diagnosed with renal limited anti-GBM disease and started on methylprednisolone and cyclophosphamide. What other treatment options should be considered?

MRCP2-3835

A 45-year-old male is being monitored in the renal clinic. His creatinine clearance is 76 ml/min and he has enlarged kidneys with multiple cysts, as seen on a recent renal tract ultrasound. His father also required dialysis at the age of 50 years. During examination, his blood pressure is measured at 149/88 mmHg. Which statement below is false?

MRCP2-3802

A 52-year-old man presents to the Emergency Department (ED) with ankle swelling and general malaise. He reports a recent decrease in exercise tolerance due to increasing breathlessness and a productive cough. On examination, he has a raised JVP, bipedal oedema, and bi-basal crackles. Investigations reveal an enlarged heart with evidence of fluid overload on CXR, and a dilated left ventricle with moderate global impairment of function on ECHO. Which factor would have the greatest impact on his long-term prognosis?

MRCP2-3811

During an evening on-call, you are summoned to the haematology ward to assess an elective chemotherapy patient. A 24-year-old male is scheduled to begin chemotherapy for Hodgkin’s lymphoma the next day and is complaining of pain in his left flank. He has been under investigation by renal physicians for the past four months due to an unknown cause of deteriorating creatinine. He is a non-regular medication user, smokes about 10 cigarettes daily, and occasionally indulges in marijuana.

Upon examination, you observe bilateral lower limb non-pitting oedema up to the knees. There is a left varicocele and mild bilateral scrotal oedema. His heart sounds and chest auscultation are unremarkable. Abdominal examination reveals only mild left renal angle tenderness. A urine dip reveals 4+ blood, 2+ protein, and normal pH. Upon reviewing his old clinic letters, you discover that a renal biopsy from two months ago showed IgG and complement deposits on the basement membrane.

His current serum results are:

K+ 5.4 mmol/l
Urea 12.8 mmol/l
Creatinine 212 µmol/l
Albumin 18 g/l

What is the most probable acute diagnosis?

MRCP2-3812

A 25-year-old female presents to her general practitioner with a 2 week history of fevers, lethargy, and weight loss. She also complains of painful eyes and visual disturbance. She has no past medical history and is not taking any medications.

On examination, her blood pressure is 130/78 mmHg and heart rate is 100 bpm. Her temperature is 37.9ºC. Both eyes are red, with conjunctival injection. Urinalysis shows protein 2+ and leukocytes 3+.

Hb 108 g/L Male: (135-180)
Female: (115 – 160)
Platelets 438 * 109/L (150 – 400)
WBC 13 * 109/L (4.0 – 11.0)
Na+ 142 mmol/L (135 – 145)
K+ 4.8 mmol/L (3.5 – 5.0)
Urea 17 mmol/L (2.0 – 7.0)
Creatinine 320 µmol/L (55 – 120)
CRP 87 mg/L (< 5) What is the most likely diagnosis?

MRCP2-3813

A 60-year-old man with progressive chronic kidney disease secondary to IgA nephropathy was seen in the nephrology clinic. He reported feeling well except for mild ankle swelling. The following blood tests were obtained:

– Hb: 104 g/L (normal range for males: 135-180; females: 115-160)
– Platelets: 276 * 109/L (normal range: 150-400)
– WBC: 8.2 * 109/L (normal range: 4.0-11.0)
– Na+: 133 mmol/L (normal range: 135-145)
– K+: 5.8 mmol/L (normal range: 3.5-5.0)
– Urea: 18.5 mmol/L (normal range: 2.0-7.0)
– Creatinine: 912 µmol/L (normal range: 55-120)
– eGFR: 5 mL/min/1.73 m² (normal range: >60 mL/min/1.73 m²)
– Bicarbonate: 17 mmol/L (normal range: 20-28)
– Calcium: 2.05 mmol/L (normal range: 2.1-2.6)
– Phosphate: 1.8 mmol/L (normal range: 0.8-1.4)

Based on this information, it was decided that he needed to start dialysis. What is the most likely reason for initiating dialysis in this case?

MRCP2-3814

A 65-year-old man with diabetic nephropathy has started regular haemodialysis and is attending a routine check-up. He is worried about having anaemia after hearing from his friend on haemodialysis. At what point should this patient be evaluated for anaemia?

MRCP2-3815

A 50-year-old man with type 2 diabetes, hypertension and proteinuria is prescribed ramipril to prevent the development of renal disease. However, he complains to his GP about a persistent cough since starting the medication. He denies any symptoms of lip swelling, wheezing, or underlying respiratory disease. What chemical is believed to be responsible for his cough?

MRCP2-3816

You are requested to assess a 26-year-old female patient admitted to the ENT ward. The patient underwent a total thyroidectomy for the management of her Graves’ disease. After a few hours of returning to the ward from the operation theatre, she started experiencing arm twitching. What is the most probable diagnosis?

MRCP2-3817

An 82 year-old man is referred to the Renal team. He was admitted 3 days previously with a community-acquired pneumonia and was being treated with co-amoxiclav and doxycycline. Over the past 24 hours he has developed a rash and reduced urine output. He was otherwise fit and well apart from mild asthma which was well controlled with a salbutamol inhaler.

On examination, his pulse was 105 beats per minute and his blood pressure was 112/64 mmHg. Urinalysis showed protein 2+ and blood 2+.

Hb 122 g/l
Platelets 468 * 109/l
WBC 8.3 * 109/l
Eosinophils 2.1 * 109/l

Na+ 133 mmol/l
K+ 5.4 mmol/l
Urea 18.5 mmol/l
Creatinine 440 µmol/l

What is the most likely diagnosis?