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?

MRCP2-2849

A 28-year-old man presents with a 2-day history of facial weakness. He also reports a 1-month history of joint pain and stiffness, particularly affecting his elbows and knees. Three months previously, he had a flu-like illness with a red rash, fever and malaise. In the preceding 6 months he had travelled to Kenya and Massachusetts, USA for cross-country running competitions.

What is the most probable diagnosis?

MRCP2-2850

A 28 year-old Lithuanian male arrives at the Emergency Department complaining of a productive cough, fever, and difficulty breathing. Upon examination, a chest X-Ray reveals consolidation in the left upper zone. Elevated white cell count and CRP indicate community acquired pneumonia, and IV antibiotics are administered. Although there is some improvement after 48 hours, the patient still requires 4L of oxygen to maintain adequate saturation. Further testing reveals a positive interferon gamma release assay for mycobacterium.

What is the appropriate next step in managing this patient’s condition?

MRCP2-2851

A 30-year-old man visits the travel walk-in centre complaining of diarrhoea that has persisted for a week after returning from a trip to Brazil. During his visit, a stool sample was taken and tested positive for Strongyloides stercoralis. What is the recommended medication for this patient?

Answer:

MRCP2-2852

A 27-year-old female patient arrives at the emergency department complaining of worsening right upper quadrant pain, particularly when taking deep breaths. The symptoms began three days ago and have been progressively getting worse. The patient has no medical history and is only taking the oral contraceptive pill and paracetamol to manage the pain. She has also noticed an increase in vaginal discharge over the past two weeks, accompanied by an unpleasant odor. The patient works in an investment bank. Upon examination, the patient has tenderness in the right upper quadrant, but the abdomen is soft and there is no organomegaly. An abdominal ultrasound reveals the presence of gallstones in the gallbladder, but is otherwise normal. What is the most likely treatment to resolve the underlying cause of her problem?

MRCP2-2853

A 28-year-old man presents to the clinic with a rash that has been present for several weeks. Upon examination, a purpuric rash is noted over all 4 limbs. His observations are within normal limits except for a slightly elevated temperature of 37.2 ºC. Blood results reveal a low Hb level, low platelet count, and elevated creatinine. His hepatitis C viral load is also high. Based on these findings, what is the most likely diagnosis?

MRCP2-2854

A 35-year-old male with HIV and a viral load of 10^6 and CD4 dropping from 500 to 300 cells/µl since his last visit. He is currently on his third line of therapy. What could be the probable reason for his recurrent treatment failures?