Clinical Sciences
Cell/molecular and membrane
(72)
biology
Clinical anatomy (67)
Clinical biochemistry and metabolism (118)
Clinical physiology (92)
Genetics (107)
Immunology (118)
Statistics (158)
Passing mark range between 63-66%
Year No. of Q
MRCP 1 May 19 100
MRCP 1 Jan 19 100
MRCP 1 Sept 18 100
MRCP 1 May 18 100
MRCP 1 Jan 18 100
MRCP 1 Sept 17 100
MRCP 1 May 17 100
MRCP 1 Jan 17 100
MRCP 1 Sept 16 100
MRCP 1 May 16 100
MRCP 1 Jan 2016 100
MRCP 1 Sept 2015 100
MRCP 1 May 2015 100
MRCP 1 Jan 2015 100
A. H. Murad
ﻻ ﺗﻨﺴﻮﻧﺎ ﻣﻦ ﺻﺎﻟﺢ دﻋﺎﺋﻜﻢ
ﺗﻢ ﺑﺤﻤﺪ ﷲ وﺗﻮﻓﯿﻘﮫ وﻣﻨﮫ
ﺟﻌﻞ ﷲ ﻋﻤﻠﻨﺎ ﻣﺘﻘﺒﻼ ﺧﺎﻟﺼﺎ ﻟﻮﺟﮭﮫ اﻟﻜﺮﯾﻢ
,A 61-year-old man with known cirrhosis secondary to hepatitis C infection attends for review.
There is a past history of intravenous heroin abuse and alcoholism. He has been feeling
progressively more unwell during the past six months, with weight loss and worsening
ascites. A pre-clinic α-fetoprotein is elevated. He is on long-term sick leave and has been
closely monitored by his live-in partner, who maintains there has been no further drug abuse
or consumption of alcohol.
A Superimposed hepatitis B infection
B Alcoholism
C Chronic active hepatitis
D Spontaneous bacterial peritonitis
E Hepatocellular carcinoma
Explanation
E Hepatocellular carcinoma
The α-fetoprotein (AFP) is elevated in 70% of patients with hepatocellular carcinoma. The
history of worsening weight loss and ascites occurring over a relatively short period is
suggestive of this diagnosis.
Risk factors for hepatocellular carcinoma include:
Chronic liver disease
Cirrhosis
Chronic hepatitis B or C infection
Hepatotoxins (alcohol, aflatoxin, anabolic steroid abuse, vinyl chloride exposure)
Alpha 1-antitrypsin deficiency
Haemochromatosis.
,The definitive diagnosis is generally made using ultrasound followed by computed
tomography-guided biopsy. Screening is difficult, but surveillance of AFP levels can result in
the earlier detection of cases. Management, unfortunately, is usually palliative. Even after
surgical resection, in the rare cases where this is possible, the survival rate is only 25–30%.
A Superimposed hepatitis B infection
Superimposed hepatitis B infection is incorrect. The patient has a deterioration in his general
state and decompensation of his hepatic function. Decompensation is known by the
worsening ascites. The lack of jaundice and symptoms of acute hepatitis make hepatitis B
less likely as an option, and also the absence of possible infective routes makes it less likely.
B Alcoholism
Alcoholism is incorrect. The lack of evidence of hepatitis, such as abdominal pain and
jaundice, makes acute alcohol hepatitis unlikely. The negative history reinforces this point as
well.
C Chronic active hepatitis
Chronic active hepatitis is incorrect. The absence of jaundice and abdominal pain makes this
less likely and would not explain the patient’s weight loss.
D Spontaneous bacterial peritonitis
Spontaneous bacterial peritonitis is incorrect. Bacterial peritonitis would have an acute onset
with abdominal pain and tender ascites. The time scale makes this less likely and would not
explain the weight loss. His ascitic fluid should be tested for malignant cells.
2206
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Difficulty: Easy
Peer Responses %
, Session Progress
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Cell/molecular and membrane
(72)
biology
Clinical anatomy (67)
Clinical biochemistry and metabolism (118)
Clinical physiology (92)
Genetics (107)
Immunology (118)
Statistics (158)
Passing mark range between 63-66%
Year No. of Q
MRCP 1 May 19 100
MRCP 1 Jan 19 100
MRCP 1 Sept 18 100
MRCP 1 May 18 100
MRCP 1 Jan 18 100
MRCP 1 Sept 17 100
MRCP 1 May 17 100
MRCP 1 Jan 17 100
MRCP 1 Sept 16 100
MRCP 1 May 16 100
MRCP 1 Jan 2016 100
MRCP 1 Sept 2015 100
MRCP 1 May 2015 100
MRCP 1 Jan 2015 100
A. H. Murad
ﻻ ﺗﻨﺴﻮﻧﺎ ﻣﻦ ﺻﺎﻟﺢ دﻋﺎﺋﻜﻢ
ﺗﻢ ﺑﺤﻤﺪ ﷲ وﺗﻮﻓﯿﻘﮫ وﻣﻨﮫ
ﺟﻌﻞ ﷲ ﻋﻤﻠﻨﺎ ﻣﺘﻘﺒﻼ ﺧﺎﻟﺼﺎ ﻟﻮﺟﮭﮫ اﻟﻜﺮﯾﻢ
,A 61-year-old man with known cirrhosis secondary to hepatitis C infection attends for review.
There is a past history of intravenous heroin abuse and alcoholism. He has been feeling
progressively more unwell during the past six months, with weight loss and worsening
ascites. A pre-clinic α-fetoprotein is elevated. He is on long-term sick leave and has been
closely monitored by his live-in partner, who maintains there has been no further drug abuse
or consumption of alcohol.
A Superimposed hepatitis B infection
B Alcoholism
C Chronic active hepatitis
D Spontaneous bacterial peritonitis
E Hepatocellular carcinoma
Explanation
E Hepatocellular carcinoma
The α-fetoprotein (AFP) is elevated in 70% of patients with hepatocellular carcinoma. The
history of worsening weight loss and ascites occurring over a relatively short period is
suggestive of this diagnosis.
Risk factors for hepatocellular carcinoma include:
Chronic liver disease
Cirrhosis
Chronic hepatitis B or C infection
Hepatotoxins (alcohol, aflatoxin, anabolic steroid abuse, vinyl chloride exposure)
Alpha 1-antitrypsin deficiency
Haemochromatosis.
,The definitive diagnosis is generally made using ultrasound followed by computed
tomography-guided biopsy. Screening is difficult, but surveillance of AFP levels can result in
the earlier detection of cases. Management, unfortunately, is usually palliative. Even after
surgical resection, in the rare cases where this is possible, the survival rate is only 25–30%.
A Superimposed hepatitis B infection
Superimposed hepatitis B infection is incorrect. The patient has a deterioration in his general
state and decompensation of his hepatic function. Decompensation is known by the
worsening ascites. The lack of jaundice and symptoms of acute hepatitis make hepatitis B
less likely as an option, and also the absence of possible infective routes makes it less likely.
B Alcoholism
Alcoholism is incorrect. The lack of evidence of hepatitis, such as abdominal pain and
jaundice, makes acute alcohol hepatitis unlikely. The negative history reinforces this point as
well.
C Chronic active hepatitis
Chronic active hepatitis is incorrect. The absence of jaundice and abdominal pain makes this
less likely and would not explain the patient’s weight loss.
D Spontaneous bacterial peritonitis
Spontaneous bacterial peritonitis is incorrect. Bacterial peritonitis would have an acute onset
with abdominal pain and tender ascites. The time scale makes this less likely and would not
explain the weight loss. His ascitic fluid should be tested for malignant cells.
2206
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Feedback End Session
Difficulty: Easy
Peer Responses %
, Session Progress
Responses Correct: 0
Responses Incorrect: 1
Responses Total: 1
Responses - % Correct: 0%
