Archives: MRCP Part 2

MRCP2-2960

A 72-year-old man presents to the Ophthalmology Clinic after being involved in a car accident and having poor visual acuity. He reports difficulty with driving due to poor distance perception and recognizing faces of friends in the supermarket over the past few months. He has a medical history of hypertension managed with lisinopril and indapamide. His blood pressure is 155/90 mmHg, and his pulse is 80 bpm and regular. Fundoscopy reveals significant bilateral optic nerve drusen and areas of geographic atrophy in both eyes. What is the most likely diagnosis?

MRCP2-2961

An 80-year-old man with a lengthy history of visual problems due to bilateral glaucoma is brought to the GP by his son. The son is worried as his father has become very obstinate and is insisting that he sees colors and patterns on the wallpaper that are not really there, and even claims to see animals and buildings outside the window. The patient has no other significant medical history, but admits to drinking a glass of wine per night. During examination, his blood pressure is 136/84 mmHg, his heart rate is 70 bpm, and he has atrial fibrillation. Visual acuity testing reveals that he is blind, but his mini-mental state testing is normal. What is the most probable diagnosis?

MRCP2-2962

A 42-year-old man has been experiencing left-sided orbital pain for the past three weeks. The pain is particularly severe in the evenings, especially when he is reading, and he has noticed a halo around lights at this time. He also experiences headaches on the same side as the orbital pain, which usually resolve when he goes to bed. However, over the past day, he has noticed a significant deterioration in his vision in the left eye.

During examination, his blood pressure is 130/80 mmHg, his pulse is 80/min and regular. His visual acuity is 6/6 in the right eye, but he can only see hand movements in the left eye. There is corneal and scleral injection on the left.

What is the most likely diagnosis for this patient?

MRCP2-2963

A 28-year-old man visits his general practitioner with a complaint of red eyes that started just yesterday. He noticed the redness while brushing his teeth in the morning. He mentions that his eyes are slightly sore but he can manage without taking any painkillers. He denies any history of itchiness and reports feeling generally well. The patient has a medical history of ankylosing spondylitis.

During the examination, the patient’s visual acuity is found to be 6/6 in both eyes. The doctor examines his eyes and makes a diagnosis.

What is the recommended treatment for this patient’s condition?

MRCP2-2940

A 16 week pregnant woman visits her doctor and reports having close contact with her niece who has been diagnosed with chickenpox two days ago. Upon further inquiry, she reveals that she has never had chickenpox before. The doctor orders a serological test for varicella zoster virus (VZV) which confirms her non-immune status. What is the best course of action for management?

MRCP2-2941

A 26-year-old woman brings her young son to the hospital as he has been feeding poorly and developed a widespread rash over the last 24 hours. The mother is 20 weeks pregnant with her second child.

After an assessment, her son’s diagnosis is confirmed as chickenpox. She has been in close contact with him throughout the illness. The mother cannot confirm whether she had chickenpox as a child, and has had no record of vaccination against VZV since.

What is the most appropriate course of action for the mother?

MRCP2-2942

A 20-year-old man presents to the Emergency department with a fever that has been ongoing for the past week. He reports that the fever occurs every other day and he also experiences a headache, but no other symptoms. It is important to note that he recently returned from Afghanistan two weeks ago. Upon examination, his temperature is 38.1ºC, heart rate is 89/min, blood pressure is 123/78 mmHg, respiratory rate is 17/min, and oxygen saturations are 99%. There is no evidence of neck stiffness, photophobia, jaundice, or splenomegaly. What is the most likely diagnosis?

MRCP2-2943

A 42-year-old woman presented with recurring sore throat, fever, joint pain and general fatigue for 4 months. She also reported a decrease in her ability to exercise.
Over the past 8 weeks, she had developed painful, red, raised lesions on her lower legs. She was diagnosed with human immunodeficiency virus (HIV) 6 years ago but had experienced difficulties with medications due to their side effects.
Investigations:
White cell count (WCC) 3.5 × 109/l 4.0 – 11.0 × 109/l
Neutrophils 0.3 × 109/l 1.5 – 7.0 × 109/l
Haemoglobin 135 g/l 130 – 180 g/l
Platelets 110 × 109/l 150 – 400 × 109/l
CD4+ count 90 × 106/l 430 – 1690 × 106/l
Chest X-ray Two cavities in the left lung field
Which pathogen is the most likely culprit?

MRCP2-2944

A 28-year-old woman presents to the clinic for evaluation. She has a history of unprotected sexual intercourse with multiple partners and has been advised to use protection, particularly during drug use. On physical examination, she has a painless ulcer with raised edges on the labia majora, and there is mild swelling of the nearby lymph nodes.

What is the most probable diagnosis?

MRCP2-2945

You are working in the liver clinic. A 29-year-old pregnant lady attends the clinic. She has been diagnosed with hepatitis C. She has no other co-morbidities and is not taking any regular medications. Hepatitis B and HIV have been excluded. She wants to know the likelihood of her baby getting infected with hepatitis C.

What is the risk of vertical transmission?