Archives: MRCP Part 2

MRCP2-2910

A 39-year-old sheep farmer presents to the Emergency Department with jaundice, fevers and right upper quadrant pain, which has developed over the past 24 hours. He also has diarrhoea and feels that he is passing much smaller amounts of dark urine compared to his normal toilet habits. He tells you that he has been clearing dead wood out of some flooded hedges over the past few days. Examination reveals a temperature of 38.9 °C and his blood pressure is 95/60 mmHg; pulse is 95 bpm. He is jaundiced. Abdominal palpation reveals marked right upper quadrant tenderness. Investigations show abnormal results for Haemoglobin (Hb), White cell count (WCC), Platelets (PLT), Sodium (Na+), Potassium (K+), Creatinine (Cr), International normalised ratio (INR), Glucose, Alanine aminotransferase (ALT), Alkaline phosphatase (ALP), and Bilirubin. The patient’s urine shows Blood ++ and Protein ++. What is the most appropriate antibiotic therapy for this patient?

MRCP2-2911

A 35-year-old male patient who is HIV positive has been admitted with Pneumocystis jirovici pneumonia (PCP). He had stopped taking co-trimoxazole therapy three weeks ago due to a rash. Blood gases show a pH of 7.19 (normal range: 7.36-7.44), pCO2 of 5.3 kPa (normal range: 4.7-6.0), and pO2 of 7.3 kPa (normal range: 11.3-12.6). Which drug combination would you choose for treating this patient?

MRCP2-2912

A 35-year-old backpacker presents to the Emergency Department with severe fever, left-sided lower abdominal pain and bloody diarrhea over the past 48 hours. He has no significant medical history and does not take any regular medication. He has been staying in hostels over the past few days where cooking and bathroom facilities are shared.

On examination, his blood pressure is 120/80 mmHg, with a postural drop of 20 mmHg on standing, and his pulse is 90 bpm.

Investigations:
Haemoglobin (Hb) – 142 g/l (normal range: 135–175 g/l)
White cell count (WCC) – 11.8 × 109/l (normal range: 4–11 × 109/l)
Platelets (PLT) – 190 × 109/l (normal range: 150–400 × 109/l)
Sodium (Na+) – 140 mmol/l (normal range: 135–145 mmol/l)
Potassium (K+) – 3.8 mmol/l (normal range: 3.5–5.0 mmol/l)
Creatinine – 120 µmol/l (normal range: 50–120 µmol/l)
Urea – 9.5 mmol/l (normal range: 2.5–7.8 mmol/l)
C-reactive protein (CRP) – 180 mg/l (normal range: < 5 mg/l)
Stool screen: Positive for Campylobacter.

He is given oral rehydration sachets and expresses his desire to continue his trip. What is the most appropriate additional intervention?

MRCP2-2902

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?

MRCP2-2904

A 75-year-old male presents to your clinic with a persistent cough, chest pain, difficulty breathing, chills, and sweats that have been ongoing for a week. Upon examination, he appears to be in relatively good health, with a temperature of 38°C and blood pressure of 110/70 mmHg. His respiratory rate is 28 breaths per minute, and there are some crepitations upon auscultation. His urea level is 4.5 mmol/L (normal range: 2.5-7.5 mmol/L), and he has a known penicillin allergy. How would you approach the treatment of this patient?

MRCP2-2905

A 25-year-old woman presents to the Gynecology Clinic with a complaint of painful urination for the past week. She is otherwise healthy. In her sexual history, she has had unprotected intercourse with two partners in the past 3 months. The patient is allergic to penicillin-based antibiotics.

During the examination, there is no vaginal discharge or tenderness. The abdomen is soft and non-tender. A vaginal swab reveals 25 neutrophils per high-power field, and no organisms are seen.

What is the most appropriate treatment for this patient?

MRCP2-2906

A 30-year-old woman has been referred to the General Medical Clinic with persistent dysuria. She has been experiencing pain on passing urine and has noticed haematuria towards the end of micturition since returning from a long trip around Asia. Despite trying a couple of antibiotics, her symptoms have not improved. Investigations reveal the presence of Schistosome eggs in her urine sample. What is the recommended treatment?

MRCP2-2907

A 25-year-old female patient presents to the Obstetrician with complaints of bilateral lower abdominal pain and a thick, yellowish vaginal discharge that has a foul odour for the past week. She reports engaging in unprotected sexual intercourse with multiple partners. Her menstrual cycles are regular and her last menstrual period was five days ago.

On physical examination, the patient has bilateral lower abdominal tenderness and cervical motion tenderness on bimanual vaginal examination. Her blood pressure is 120/70 mmHg, heart rate 96 bpm and temperature 37.8 °C.

What is the most appropriate course of action for managing this patient’s symptoms?

MRCP2-2908

A 42-year-old woman with a history of type 1 diabetes and chronic renal failure received a renal transplant eight weeks ago. She presents to the Emergency Department with a dry cough and increasing shortness of breath, limiting her exercise tolerance to 50 m. She is taking multiple immunosuppressive agents. On examination, she has a temperature of 38.2 °C, blood pressure of 145/82 mmHg, and pulse of 82 bpm. Crackles and wheezes are heard across both lung fields, and her oxygen saturation drops to 91% with exertion. Investigations reveal a low haemoglobin level, elevated white cell count, and C-reactive protein. Chest X-ray shows perihilar fluffy opacities. What is the most appropriate intervention?