A 42-year-old teacher presents to her GP with a fever that has been coming and going for the past 4 days. She reports feeling generally lethargic for the past week, with occasional lower back pain and aching limbs. On examination, she is tender in her sacral region and has an enlarged liver and spleen. The following blood test results are obtained:
Which pathogen is most likely responsible for this woman’s symptoms?
MRCP2-2922
A 43-year-old woman presents to the emergency department with a 5-day history of high fevers and myalgia. She has recently returned to the US from the Democratic Republic of the Congo. Her medical history includes uterine fibroids and iron deficiency anemia, which she manages with regular ferrous sulfate.
Her vital signs are as follows: – Temperature: 39.2ºC – Heart rate: 120 bpm – Blood pressure: 110/70 mmHg – Respiratory rate: 16 breaths/min – Oxygen saturation: 98% on room air
Upon examination, she is diaphoretic and reports a headache. Her lung sounds are clear and her heart sounds are regular. Her abdomen is soft and non-tender. However, she has multiple enlarged and tender lymph nodes in her axillae and groin.
What is the most likely infectious agent responsible for her symptoms?
MRCP2-2923
A 54-year-old male presents with a persistent cough, fatigue, fever, and shortness of breath. He has been feeling unwell for the past 6 months with recurrent colds that he cannot seem to shake off. During this time, he has lost around one and a half stone in weight due to a poor appetite. His medical history only includes asthma. He has been a widower for 7 years and enjoys traveling the world for wildlife photography. His last trip was to Africa 2 years ago.
During examination, his temperature is 38.2ºC, heart rate is 102/min and regular, blood pressure is 110/70 mmHg, and saturations are 92% air. Fine bibasal crackles are heard on chest auscultation, and his arterial blood gas shows a type 1 respiratory failure. Bilateral pulmonary infiltrates are seen on his chest x-ray. He is treated with intravenous antibiotics, but his condition worsens after two days of admission, and he requires continuous positive airway pressure (CPAP). The beta glucan test and urinary antigens are negative. The patient reports experiencing blurred vision, flashing lights, and spots in his right eye.
What is the most likely diagnosis?
MRCP2-2924
A 16-year-old male presents to the infectious disease department with a fever, sore throat, and swollen lymph nodes. He has been feeling unwell for the past three days and noticed some yellowing of his eyes. Upon routine blood testing, the following results were obtained:
The patient denies any history of travel or sexual activity and has never used intravenous drugs. What is the most likely causative organism?
MRCP2-2925
A 16 year old girl arrives at the emergency department with her worried mother. She was born and raised in England, but her parents come from a rural rice farming community in China. She recently returned from a trip to China where she had close contact with dogs, sheep, and pigs on her family’s farm. She had been taking Mefloquine for malaria prevention during her travels.
Yesterday, she complained of a fever and headache, and today she is confused and disoriented. She has no history of medical problems, has received all of her UK immunizations, and is a successful student and active member of her college’s canoe club. She has no known allergies.
During the examination, she is febrile at 38.9°C but stable in terms of her blood pressure and heart rate. She appears confused and has difficulty walking. It is challenging to examine her cranial nerves, but there are no obvious abnormalities. She has normal strength but increased tone in her arms, which is more pronounced on the left side, and hyperreflexia on both sides. During the consultation, she has several involuntary writhing movements in her upper limbs.
A CT scan reveals hypodensity in the thalami and basal ganglia bilaterally, with more pronounced effects on the left side. A lumbar puncture shows lymphocytic cerebrospinal fluid with elevated protein levels.
What is the most probable diagnosis?
MRCP2-2926
A 49-year-old farmer presents with a three-day history of headache, fever, and vomiting. He has been undergoing chemotherapy for mantle cell lymphoma and completed his fourth cycle three days ago. Despite his treatment, he has continued to work on his dairy farm. He has no significant medical history, does not smoke or drink. On examination, the patient is lethargic and has a fever of 38.6 degrees. There are no rashes on his skin, but he displays neck stiffness and photophobia. A neurological examination is not possible, but there is no obvious facial asymmetry, and the patient is moving all four limbs. Both plantars are downgoing.
A lumbar puncture is performed, and the cerebrospinal fluid examination shows:
– WCC 200 x 106/litre (70% neutrophil 25% lymphocytes) – RBC 4 x 106/litre – Glucose 1.7 mmol/l (normal 3.3-4.4 mmol/l) – Microscopy No organisms on gram stain – Appearance cloudy
The patient is immediately started on intravenous ceftriaxone for suspected bacterial meningitis. After 48 hours, blood and cerebrospinal fluid cultures are still pending, and the patient’s clinical state has not changed. What is an appropriate additional therapy?
MRCP2-2927
A 35-year-old woman presents to the Emergency Department. She has just returned from her trip to Thailand and is worried about the risk of contracting rabies. She had a minor bite from a stray dog while on her trip, but she immediately cleaned the wound. She has no past medical history and takes no regular medications. On examination, all of her vital signs are within normal limits and the wound has healed. What is the best course of action to manage this patient’s risk of rabies?
MRCP2-2928
A 30-year-old farmer presents to the Emergency Department with a one week history of lethargy and subjective pyrexia. Over the past 24 hours he has developed left sided pleuritic chest pain which brought him to hospital.
He denies any past medical history and had been systemically well prior to this. He denies any recent overseas travel.
Examination reveals left sided coarse crackles in the lungs, there is no abnormality heard in the right side of the lung.
His observations revealed heart rate 100 beats per minute, oxygen saturation 97% in room air, temperature 38.2ºC, respiratory rate 20 breaths per minute, blood pressure 140/90 mmHg.
An ECG was performed which revealed sinus tachycardia and his chest radiograph revealed left sided consolidation.
His blood results taken on admission were as follows:
An 82-year-old man is brought to the hospital by his caregiver after being found confused and in pain. He typically manages his own care with assistance for household tasks, but today he was found slumped in a chair complaining of right knee pain and yelling for help. He has a history of gout and drinks four pints of beer daily, and it is unclear if he takes his blood pressure medication as prescribed. Upon examination, he has a fever of 39.1°C, a blood pressure of 95/70 mmHg, and a regular pulse of 95 bpm. His right knee is swollen and erythematous, and he can only flex it 30 degrees. Lab results show a low hemoglobin level, high white cell count and C-reactive protein level, and elevated urate and creatinine levels. The knee joint aspiration reveals negative birefringent crystals and 350 × 109 neutrophils/ml. What is the most appropriate course of action?
MRCP2-2903
A 24-year-old pregnant woman at 26 weeks gestation presents to the Emergency Department with flu-like symptoms, diarrhoea, and a worsening headache over the past 48 hours. She reports attending a wedding where canapés were served four days prior. On examination, she is febrile, has left-sided abdominal tenderness, and clear signs of meningism. Laboratory investigations reveal leukocytosis, elevated CRP, and abnormal CSF findings consistent with bacterial meningitis. What is the most appropriate intervention for this suspected diagnosis?