MRCP Part 2 Category: Dermatology

MRCP2-0907

A 56-year-old man presents to the dermatology clinic with a hyperpigmented rash on his neck, axillae, and groin that has worsened over the past few weeks. He reports increased shortness of breath and decreased exercise tolerance over the past 3 months. He is a smoker and has COPD, which is treated with a high dose salmeterol/fluticasone inhaler. On examination, he has a blood pressure of 132/82 mmHg, a pulse of 65 beats per minute, and a BMI of 22 kg/m². There is a quiet wheeze on chest auscultation and mild tenderness in the epigastrium.

Investigations reveal a hemoglobin level of 90 g/l, platelets of 191 * 109/l, WBC of 7.0 * 109/l, and elevated CRP and ESR levels. His electrolyte and renal function tests are within normal limits.

What is the most appropriate next investigation to perform?

MRCP2-0908

A 20-year-old man presents with tear-drop papules on his trunk and limbs. He is asymptomatic otherwise. The clinician suspects guttate psoriasis. What is the best course of action for management?

MRCP2-0909

A 68-year-old woman presents with erythematous, rough lesions on the back of her hands. After diagnosis, it is determined that she has actinic keratoses. What is the best course of action for management?

MRCP2-0910

An 83-year-old man visits the dermatology clinic with scalp changes. He is bald and has noticed thickened and abnormal skin. He has a history of sun exposure from living in Spain for five years but has now returned to the UK permanently. He also has a history of smoking, but quit 15 years ago, and has quit drinking. He has been diagnosed with COPD, fractured NOF, gout, and hypertension. He regularly uses ipratropium, seretide, allopurinol, ramipril, amlodipine, and alendronic acid.

During the examination, the scalp appears erythematous with thickened plaques. It is mildly tender and slightly irritated. What is the most suitable treatment?

MRCP2-0911

The following patient is undergoing treatment for epilepsy:

What is the probable underlying diagnosis for this case?

MRCP2-0912

A 32-year-old man comes to the clinic complaining of a rash on his foot. He reports that he first noticed it four weeks after returning from Thailand. The rash is extremely itchy and has been causing him sleepless nights. He has no medical history and does not take any medications regularly. During the examination, a serpiginous track with erythema and oedema is observed on the superior aspect of his right foot.

What is the preferred treatment for this ailment?

MRCP2-0913

A 78-year-old female presents to the hospital after experiencing a seizure where she lost consciousness and had twitching in all four limbs. She has a history of a previous stroke resulting in mild right-sided weakness and is also a type 2 diabetic. The patient is diagnosed with her first generalized seizure and is prescribed lamotrigine. During her hospital stay, she develops a sore throat and the following day, the healthcare provider notices peeling skin on her lower lip and a new well-defined red rash on her trunk. What is the most likely diagnosis?

MRCP2-0914

A 42-year-old woman presents to the Rheumatology Clinic for evaluation. She has been diagnosed with rheumatoid arthritis and has been on various treatments, including methotrexate and biologic agents, but has not experienced significant improvement in her symptoms. She reports joint pain and stiffness, particularly in her hands and feet, which is affecting her ability to work as a hairdresser.
On examination, there is evidence of synovitis in multiple joints, including the wrists, metacarpophalangeal joints, and ankles. Laboratory investigations reveal the following:
Investigations Results Normal Values
Haemoglobin (Hb) 129 g/l 120–160 g/l
White cell count (WCC) 7.8 × 109/l 4.0–11.0 × 109/l
Platelets (PLT) 240 × 109/l 150–400 × 109/l
Sodium (Na+) 139 mmol/l 135–145 mmol/l
Potassium (K+) 4.1 mmol/l 3.5–5.0 mmol/l
Creatinine (Cr) 90 µmol/l 50–120 µmol/l
Alanine aminotransferase (ALT) 42 IU/l 5–30 IU/l
Alkaline phosphatase (ALP) 80 IU/l 30–130 IU/l
Bilirubin 10 µmol/l 2–17 µmol/l
Erythrocyte sedimentation rate (ESR) 45 mm/hour 1–20 mm/hour

What is the most appropriate next step in management for this patient?

MRCP2-0915

A 67-year-old woman presents to the cardiology clinic after being admitted for a NSTEMI. During her hospital stay, an echocardiogram revealed mild-moderate LV systolic dysfunction with an ejection fraction of 40%. She reports feeling well since discharge, but experiences mild breathlessness when climbing two flights of stairs. During the examination, the physician notices a rash on her lower legs consisting of tense blisters and minimal underlying edema. Which medication is most likely responsible for the rash?

MRCP2-0916

A 30-year-old woman presents to the ED with a sudden onset rash. She reports feeling fatigued lately with a sore throat and cough. She is a smoker of 10 cigarettes/day.

During the examination, the patient has multiple painful erosions on the inside of her lips, an inflamed throat, and diffuse wheezing. On her palms and forearms, she has several swollen papules, some of which have small blisters in the center, forming a target-like lesion.

What is the most probable trigger for her condition?