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?
MRCP2-2945
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?
MRCP2-2946
A 25-year-old patient presented to their GP with fever and epistaxis. The fever had started 6 days earlier and was accompanied by a headache and malaise. After being prescribed amoxicillin for 3 days without improvement, the patient became so ill that they refused to eat and started vomiting.
Their medical history included mumps at the age of nine, and their father had been diagnosed with liver cirrhosis 2 years ago due to excessive alcohol consumption. The patient is a regular smoker for the last 10 years and lives in a dorm. Two weeks earlier, they had been in rural Central Africa as a reporter covering the conflict there. They denied being vaccinated for any disease before going there but did take anti-malarial tablets.
On examination, the patient appeared ill with a temperature of 38ºC and jaundice. Eye examination revealed conjunctival hemorrhages on both eyes. All other systems were normal.
A 29-year-old man who has recently immigrated from Nigeria presents with a penile ulcer. He reports that it initially started as a small lump but then later progressed to a painful ulcer.
Upon examination, there is a 7mm diameter tender single ulcer with an undermined ragged edge just proximal to the glans of the penis. The testes and anal region appear normal. However, there is tender inguinal lymphadenopathy.
What is the probable diagnosis?
MRCP2-2930
A 32-year-old female presents to the clinic with a 1-week history of lower abdominal pain and deep dyspareunia. She denies any lower urinary tract symptoms but has noticed occasional creamy vaginal discharge. She has no significant medical history and takes no regular medications. On examination, she has lower abdominal tenderness and is guarding in the left iliac fossa. Bimanual examination elicits bilateral adnexal tenderness. Swabs are taken, and investigations reveal a raised CRP and +++ leucocytes in the urinalysis. What is the most likely causative organism contributing to this patient’s diagnosis?
MRCP2-2931
You are seeing a patient in the HIV Outpatients Clinic who was diagnosed HIV-positive 6 weeks ago at the age of 60 and has a CD4 count of 12 × 106/l. He is planning to go mountain trekking in the Himalayas for the next three weeks and wants to reduce his risk of catching a range of infections. However, he developed a rash and derangement of his liver function tests when he was previously given prophylactic co-trimoxazole. Despite your advice that he needs to be more immunocompetent before he goes, he is determined to go on the trip as it was organised months ago and is for charity. He would like some information about vaccinations and wants to know which ones are safe for HIV-positive patients. What group of vaccines would you recommend for him, both routine and for travelling purposes?
MRCP2-2932
A 70-year-old male diabetic presents to the hospital with severe cellulitis of his left leg. He has a history of hypertension and coronary artery disease. Upon examination, he has a temperature of 38.5°C, a pulse of 110 bpm, and a blood pressure of 150/95 mmHg. His left leg is swollen, tender, and has marked erythema. Lab reports show Hb of 92 g/l, MCV of 72 fl, WBC of 24 * 109/l, Plt of 480 * 109/l, urea of 9.5 mmol/l, and creatinine of 140 µmol/l. Urine examination reveals proteinuria 1+ and glycosuria 2+. Blood cultures reveal the growth of MRSA. What is the most appropriate antibiotic for this patient?
MRCP2-2933
A 23-year-old woman with lupus and antiphospholipid syndrome presented to the Rheumatology clinic complaining of sharp chest pain on her right side. The pain had started three days prior to her visit and was accompanied by shortness of breath. She also reported a vesicular rash that had appeared over the affected area one day ago. The patient weighs 65 kg and is currently taking Methotrexate 20 mg once weekly, Prednisolone 30 mg once a day, Aspirin 75 mg once a day, and Folic Acid 5 mg once a day. Upon admission to the rheumatology ward, a CTPA was performed which showed no pulmonary emboli, but widespread bilateral changes of subsolid nodules and ground-glass opacification. The patient’s shortness of breath continued to worsen and her vital signs were taken: temperature 39.1 °C, blood pressure 107/55, heart rate 122, and oxygen saturation 88% on air. What is the most appropriate treatment for her likely diagnosis?