Archives: MRCP Part 2

MRCP2-2767

What intervention is most effective in decreasing the likelihood of bloodstream infection from a central venous catheter (CVC)?

MRCP2-2768

A 25-year-old female presents with a frontal headache accompanied by fever and photophobia. She reports having an ear infection for the past week. Lumbar puncture results show a cell count of 228 (95% neutrophils), protein level of 1.2 g/l (normal 0.2-0.4), and glucose level of 2.2 mmol/l. Her plasma glucose level is 6.8 mmol/l. What is the probable causative organism?

MRCP2-2769

A 55-year-old man presents to the Emergency Department with worsening symptoms over the past two weeks. He initially experienced fevers and increasing shortness of breath, but in the last 24 hours, he has had several episodes of haemoptysis and bloody diarrhoea. What is the probable underlying diagnosis?

MRCP2-2770

A 29 year-old man comes to his physician complaining of bone pain and a rash. X-rays of his limbs show multiple osteolytic lesions. He was effectively treated for secondary syphilis.

What test is expected to stay positive in this patient even after treatment?

MRCP2-2771

A 20-year-old male presents to the general medical take with large grey lesions around his perineum and in his mouth which started 2 days ago. He reports that he has a more general rash on his trunk and the palms and soles of his feet. He generally feels unwell with malaise and fever. He has never had anything like this before but mentions that he did see a small ulcer on his scrotum a month ago that didn’t hurt and healed on its own. What is the most likely diagnosis?

On examination, he has a symmetrical, widespread, maculopapular rash on his trunk, limbs and the palms and soles of his feet. This is different from the large greyish lesions that you see in his mouth and perineum. He has general lymphadenopathy that is minimally tender on palpation. His chest is clear on auscultation, there are no added heart sounds and his abdomen is soft and non-tender. Investigations show: Haemoglobin 13g/dl, WCC 11 x 10^9/l, Platelets 352 x 10^9/l, CRP 89 mg/L, Sodium 145 mmol/l, Potassium 3.8 mmol/l, Urea 4 mmol/l, Creatinine 82 µmol/l.

MRCP2-2743

A 45-year-old man has been experiencing confusion and decreased mental function, as well as loss of coordination and movement in his right arm for the past six weeks. An MRI scan has revealed lesions in the white matter and grey-white junction of his cerebral hemispheres, indicating demyelination. A stereotactic biopsy was performed, and immunohistochemical staining of the tissue showed the presence of JC papovavirus in oligodendrocytes. Which of the following laboratory test results is most likely to be associated with these findings?

MRCP2-2744

A 32-year-old female presented to the emergency department with a rash. She had a history of taking oral contraceptives but was otherwise healthy. The patient had been exposed to her niece with chickenpox and had developed a widespread, itchy, blistering rash over the past 8 days. She began to feel unwell with a high fever and a painful left calf. The next day, she noticed an area of redness on her lower leg that became increasingly painful and enlarged throughout the day.

Upon examination, the patient appeared ill. She had healed chickenpox scars and scabs on her lower limbs and torso. There was a diffuse, tender, and swollen rash extending from her mid-calf to her ankle. Although she had normal joint mobility, her movements were limited by pain.

The patient’s vital signs were as follows:
– Temperature: 39.7ºC
– Respiratory rate: 24/min
– Blood pressure: 91/55 mmHg
– Heart rate: 112 bpm
– Oxygen saturations: 98% on room air

Her blood test results were:
– Hemoglobin: 109 g/L (normal range: 115 – 160)
– White blood cell count: 20 * 109/L (normal range: 4.0 – 11.0)
– C-reactive protein: 208 mg/L (normal range: < 5) The patient was given intravenous fluids, analgesia, and broad-spectrum antibiotics. Her IV morphine was increased to control her pain. The next day, she remained tachycardic and tachypneic. The area of erythema had extended proximally to 2 cm below her knee, and a small area of dark purple-black discoloration was present at the distal aspect of the rash. What is the most appropriate next step in managing this patient?

MRCP2-2745

You are requested to assess a patient with acute respiratory failure caused by H1N1 influenza virus infection. You must wear complete personal protective equipment while managing the patient in a negative pressure isolation room.

What is the appropriate sequence and site for removing this protective gear?

MRCP2-2746

A 45-year-old woman has approached the infectious diseases team seeking advice on antibiotic prophylaxis for Lyme disease. She plans to go on a two-week walking holiday in the Lake District National Park in Cumbria, UK, and is concerned about the risk of tick bites. Her younger sister had suffered serious neurological complications from Lyme disease after a tick bite in the Scottish Highlands, which has made her anxious about contracting the disease. She wants to receive prophylactic antibiotics against Borrelia species during her trip.

The patient has a medical history of breast cancer, which was treated with surgery and chemotherapy seven years ago. She has been cleared by her oncologists and discharged from follow-up. She also has long-standing symptoms of irritable bowel syndrome and takes hyoscine butylbromide for treatment. She is allergic to penicillin-based antibiotics, having experienced a protracted episode of diarrhea after a previous course of penicillin V. She is a full-time music teacher, married with three teenage children, and consumes approximately 10 units of alcohol per week.

What is the appropriate management for this patient’s request for antibiotic prophylaxis against Lyme disease during her walking holiday?

MRCP2-2747

A 25-year-old woman was admitted to the Emergency Unit with a fever and body aches. On examination, she was febrile at 39.2 °C, with a BP of 110/70 mmHg and a pulse of 95/min and had a maculopapular rash. There was significant neck stiffness and signs of meningism. Apparently, two other cases of meningococcal meningitis have been reported in the past two weeks in her workplace.
Investigations reveal the following:

Haemoglobin (Hb) 120 g/l 120–160 g/l
White cell count (WCC) 8.5 × 109/l 4.0–11.0 × 109/l
Platelets (PLT) 200 × 109/l 150–400 × 109/l
Sodium (Na+) 140 mmol/l 135–145 mmol/l
Potassium (K+) 4.0 mmol/l 3.5–5.0 mmol/l
Creatinine (Cr) 80 µmol/l 50–120 µmol/l
Lumbar puncture Gram-negative diplococci identified
She has stays with her 20 year old sister on the contraceptive pill. Which of the following would be the most appropriate prophylaxis against infection for her sister?