Archives: MRCP Part 2

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?

MRCP2-3807

A 35-year-old teacher who spent two years teaching in a high-stress environment is referred by her primary care physician to your general medicine clinic for recurring migraines. During the medical history, it becomes apparent that she suffers from migraines and has a significant caffeine intake. Upon further questioning, she confides that she often experiences flashbacks of her time teaching and is having difficulty sleeping. She explains that she frequently feels anxious and has become socially withdrawn. She also reveals that she has been feeling increasingly depressed and has had occasional suicidal thoughts. What is the most appropriate course of action?

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?

MRCP2-3811

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?

MRCP2-3816

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?

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?

MRCP2-3812

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?

MRCP2-3818

A 28-year-old female patient presents with a widespread maculopapular rash accompanied by fever and lower back pain. She has also noticed swelling in both her legs. The patient had visited her GP three weeks ago and was prescribed amoxicillin for a chest infection. A urinalysis was performed, and the results are as follows:

Urinalysis
Blood +++
White cells +++ (eosinophils+++)
No organisms seen
Glucose –
Nitrates –

Blood tests:

Hb 10.6 g/dl
MCV 86 fl
Platelets 390 * 109/l
WBC 9.2 * 109/l

Na+ 136 mmol/l
K+ 4.2 mmol/l
Urea 12.4 mmol/l
Creatinine 135 µmol/l

What is the most probable diagnosis?

MRCP2-3801

You are requested to evaluate a 29-year-old woman who has been admitted to the ward after taking an overdose of Paracetamol. She is causing a disturbance on the ward and her partner informs you that she has a gambling addiction and has spent a significant amount on credit cards for unnecessary items. When you approach her, she is highly agitated and threatens to open an Emergency exit from the third floor ward, claiming that she can fly. She has declined observations from the nursing staff and has removed her N-acetylcysteine IV.
What is the most suitable pharmacological intervention in this case?