Archives: MRCP Part 2

MRCP2-2855

A 23-year-old woman, diagnosed 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. Her current medications include Methotrexate, Prednisolone, Aspirin, and Folic Acid. Upon admission to the rheumatology ward, a CT pulmonary angiography was performed, which showed no pulmonary emboli but revealed widespread bilateral changes of subsolid nodules and ground-glass opacification. As her shortness of breath worsened, her vital signs were taken, revealing a temperature of 39.1ºC, blood pressure of 107/55 mmHg, heart rate of 122 beats/min, and oxygen saturation of 88% on air. What is the most appropriate treatment for her likely diagnosis?

MRCP2-2856

A 29 year-old accountant presented to the general medical clinic with persistent nasal stuffiness and intermittent epistaxis. The ear, nose and throat team had already prescribed intranasal steroids without improvement. The patient’s medical history was unremarkable, but he had traveled to South America 8 years ago. He was a non-smoker and consumed 20 units of alcohol per week. On examination, there was superficial ulceration of the nasal mucosa bilaterally. The chest was clear and heart sounds were normal.

What is the most likely pathogen responsible for the patient’s symptoms?

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?

MRCP2-2858

A 28-year-old man who recently moved to the UK from Ethiopia presents with a chronic cough and night sweats that have persisted for five weeks. He also reports coughing up small amounts of bright red blood on a few occasions, which is particularly concerning to him as his father died from lung-related issues following chronic coughing.

After undergoing a chest X-ray and blood tests, he is diagnosed with TB and contact tracing is initiated. His 26-year-old male partner lives with him and is identified as being at high risk of contracting TB. The partner undergoes Mantoux testing and has a 2mm area of induration. He has never received BCG vaccination to his knowledge and has no vaccination scar. What is the most appropriate management that should be offered to the partner?

MRCP2-2859

A 56-year-old woman arrives at the emergency department with a sore throat and a temperature of 38.2ºC. She reports no other symptoms and denies coughing, chest pain, dysuria, and diarrhea. She is currently receiving chemotherapy for breast cancer, with her last treatment being six days ago. What is the best course of treatment for her?

MRCP2-2860

A 40-year-old woman presents to the emergency department with a one day history of fever. She has a medical history of metastatic breast cancer and received chemotherapy 10 days ago. She is not taking any regular medications.

Her vital signs are heart rate 110 beats per minute, blood pressure 95/60 mmHg, respiratory rate 22/minute, oxygen saturation 97% on room air, and temperature 38.8ºC.

During examination, she is warm to touch with capillary refill time < 2 seconds. A bounding pulse is noted. No apparent source of infection is found from the rest of the examination. Urinalysis results are normal. Chest radiography shows no abnormalities. Blood tests reveal: – Hemoglobin (Hb) 120 g/L (Female: 115 – 160)
– Platelets 389 * 109/L (150 – 400)
– White blood cells (WBC) 1.7 * 109/L (4.0 – 11.0)
– Neutrophils (Neuts) 0.4 * 109/L (2.0 – 7.0)
– Lymphocytes (Lymphs) 0.9 * 109/L (1.0 – 3.5)
– Monocytes (Mono) 0.2 * 109/L (0.2 – 0.8)
– Eosinophils (Eosin) 0.2 * 109/L (0.0 – 0.4)
– Sodium (Na+) 137 mmol/L (135 – 145)
– Potassium (K+) 4.4 mmol/L (3.5 – 5.0)
– Bicarbonate 20 mmol/L (22 – 29)
– Urea 8.9 mmol/L (2.0 – 7.0)
– Creatinine 111 µmol/L (55 – 120)
– C-reactive protein (CRP) 180mg/l (<4) What is the appropriate antibiotic choice?

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?

MRCP2-2865

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?