Archives: MRCP Part 2

MRCP2-2883

A 15-year-old boy presents to the Emergency department at 9 pm with complaints of headache, fever, and diarrhea. He had an episode of watery diarrhea at 6 pm and has since become increasingly unwell. He has no significant medical history and was feeling well the previous day. There is no recent travel history, and his family members have been healthy. On examination, he has a fever of 39.5°C, a blood pressure of 80/50 mmHg, and a heart rate of 110 per minute. He complains of a headache and mild photophobia, but there is no nuchal rigidity. His chest is clear, and his abdomen is soft and non-tender. Investigations reveal a hemoglobin level of 130 g/L, a WBC count of 18.5 ×109/L, and a platelet count of 200 ×109/L. His serum electrolytes, liver function tests, and lactate dehydrogenase levels are within normal limits. What is the likely diagnosis?

MRCP2-2884

A 35-year-old woman presented with a 24-hour history of high fever, vomiting, diarrhea, and severe muscle pain. Four days ago, she finished a 5-day course of oral ciprofloxacin for a urinary tract infection. She also takes the oral contraceptive pill, and her last menstrual period ended the previous week.

During the examination, her temperature was 40.2 °C, heart rate 140 bpm, and BP 80/50 mmHg. There was no nuchal rigidity or photophobia. She had a widespread macular erythrodermic rash on her chest and legs, and significant tenderness in her thigh muscles. She also had diffuse abdominal tenderness. Neurological examination showed no abnormalities.

Investigations:
Investigation Result
Blood cultures No growth in two samples after 48 hours
Urine cultures No growth

What is the most likely diagnosis?

MRCP2-2885

A 26-year-old HIV-positive male presents to his GP with new-onset headache and weakness on the left side of his body. Upon examination, his temperature is 38ºC, blood pressure is 115/70 mmHg, respirations are 14/min, and pulse is 73/min. Neurological assessment reveals reduced strength, hyperreflexia in the left upper and lower limb, and upgoing plantars. A CT scan of the head shows multiple ring-enhancing lesions.

What would be the most appropriate course of action for managing this patient?

MRCP2-2886

A 35-year-old HIV-positive man presents with a two-week history of deteriorating headache, facial weakness, and visual hallucinations. He also reports experiencing eye pain for the first time. An MRI scan of his head shows multiple ring-shaped lesions that enhance with contrast. He is under regular follow-up at the HIV clinic, and his most recent CD4 count was 150 cells/mm³. What is the immediate treatment that should be initiated?

MRCP2-2857

A 32 year-old man from South Korea presents with a three week history of abdominal pain in the right upper quadrant, fever and weight loss. The pain is localized and rates 7/10 on the pain scale. He denies any other symptoms and has no significant family history except for his father who has hepatitis B and HIV. On examination, a 4cm tender palpable liver edge is noted along with pyrexia of 39.2ºC and right upper quadrant pain. There is no jaundice.

Laboratory tests reveal:

– Bilirubin: 32 µmol/l
– ALP: 220 u/l
– ALT: 95 u/l
– γGT: 110 u/l
– Albumin: 36 g/l

An ultrasound scan is performed and shows a 4x4cm abscess in the right lower lobe of the liver. The abscess is drained through aspiration. What is the most appropriate treatment for this patient?

MRCP2-2861

An 82-year-old nursing home resident comes to you with symptoms of pyrexia, myalgia, and coryza that have been present for 48 hours. During the examination, you notice that the patient has a temperature of 37.9ºC and is visibly coryzal. Upon auscultation, her chest is clear. A chest X-ray also shows no abnormalities. The patient’s family members inform you that the nursing home has recently been closed to visitors due to an outbreak of Influenza. Given this information, what medication should you consider adding to the patient’s treatment plan?

MRCP2-2862

A 70-year-old man visits the tuberculosis clinic with complaints of worsening lower back pain over the past 6 months. Despite taking analgesics, the pain has become unbearable and has affected his mobility. He lives with his wife on their farm and has been independent until now. His medical history includes hypertension, diet-controlled type 2 diabetes mellitus, and benign prostatic hypertrophy. He had tuberculosis at the age of 25, but he cannot recall the treatment he received. An MRI of his spine reveals lumbar 4/5 discitis, and a biopsy is scheduled, which grows acid-fast bacilli on culture. What is the appropriate treatment regimen for this patient?

MRCP2-2863

A 30-year-old man presents to his primary care physician with a two-month history of dysphagia and odynophagia. He has a medical history of HIV but is non-compliant with his anti-retroviral treatment.

Observations:

Heart rate: 88 beats per minute
Blood pressure: 120/72 mmHg
Respiratory rate: 18/minute
Oxygen saturations: 98% on room air
Temperature: 37ºC

During the examination, white patches are observed on the gums, tongue, and extending beyond the pharynx. Other than that, the examination is unremarkable.

What is the most suitable treatment?

MRCP2-2864

A 47-year-old man presents to the acute medical unit with a 3-week history of pain and difficulty when swallowing. He reports a weight loss of approximately 2-3 kg due to reduced oral intake. The patient has a medical history of previous hospital admissions for lower respiratory tract infections and lower limb deep vein thrombosis.

Upon examination, the patient appears cachectic with multiple well-defined white plaques over the oral mucosa. His abdomen is soft and non-tender with no palpable masses.

CD4 count < 100 cells/mm³ What is the most appropriate course of action for managing this patient?

MRCP2-2865

A 26-year-old female came to the clinic complaining of dysuria and a recent onset of vaginal discharge. She has been engaging in unprotected sexual activity with a new male partner for the past six weeks. Her NAAT test showed positive results for Chlamydia and negative for gonorrhoeae infection. She is currently on her menstrual cycle.

What is the recommended initial treatment for this infection?