Archives: MRCP Part 2

MRCP2-2732

A 23-year-old office worker presents to the clinic with complaints of swollen and tender finger joints that have been present for a few weeks. She has no significant medical history except for a recent viral illness. She denies any recent travel and reports that some of her colleagues at work have also been sick with a similar illness. On examination, there is swelling and tenderness in the metacarpophalangeal and proximal interphalangeal joints of both hands. What is the probable diagnosis?

MRCP2-2733

A 67-year-old American man is seen in the HIV Clinic. He has a CD4 count of 120 × 106/L and was started on prophylactic co-trimoxazole 2 weeks ago. Unfortunately, this resulted in a severe rash and deranged liver function tests and was discontinued.
He has glucose-6-phosphate dehydrogenase (G6PD) deficiency and is a type 2 diabetic. His only current medication is metformin 500 mg bd.
What is the most appropriate prophylaxis for Pneumocystis jirovecii pneumonia (PCP)?

MRCP2-2734

A 22-year-old woman arrives at the emergency department complaining of feeling exhausted, coughing, having fevers and feeling generally lethargic for the past five days. She becomes emotional during the consultation as she has never experienced this before.

Upon examination, she displays tenderness over both trapezius muscles, her temperature is 38.6 ºC and her throat is red without any pus collections.

A rapid point of care test confirms that she is positive for influenza.

What would be your next course of action?

MRCP2-2735

A 55-year-old man presents to his GP with a case of multi-dermatomal shingles and is subsequently diagnosed with HIV. His CD4 count is 480 cells/μL. What are the appropriate immunisation recommendations for this patient?

MRCP2-2736

A 28-year-old IV drug user presents with a two week history of non-productive cough, fatigue, shortness of breath and fever. On examination, he has a respiratory rate of 28, a heart rate of 90 and was hypoxic on exercise.

His blood test results were as follows:
– Haemoglobin: 110 g/L (135-180)
– White cell count: 3 ×109/L (4-11)
– Neutrophils: 2.5 ×109/L (1.5-7.4)
– Lymphocytes: 0.4 ×109/L (1.1-4.0)

Chest x-ray was normal. Which investigation would be diagnostic?

MRCP2-2737

A 50-year-old patient is admitted to the acute medical unit with a 10-day history of a dry cough and progressive shortness of breath, particularly on exertion. He also complains of intermittent fevers and a general loss of appetite. His past medical history includes HIV and he is non-compliant with his regular medications.

His observations are as follows:
Temperature 38.3ºC
Heart rate 112 beats/min
Blood pressure 123/84 mmHg
Respiratory rate 25 breaths/min
Oxygen saturations 94% on air, 83% on exertion

On examination, he appears pale and cachectic. There are audible crackles bilaterally. His heart rate is regular and heart sounds are normal. He has a soft and non-tender abdomen.

Laboratory tests:

CD4 count < 200/mm³ Which of the following complications is most commonly associated with the likely underlying diagnosis?

MRCP2-2738

A 43-year-old man presents to the Emergency department with a one month history of dry cough, shortness of breath, and a six-month history of weight loss. He is a non-smoker. Two months ago, he was discharged from the hospital after being treated for pneumonia caused by Streptococcus pneumoniae. His past medical history includes a case of shingles treated by his GP a year ago. On examination, he appears breathless but is able to complete sentences. His temperature is 37.5°C, blood pressure is 110/76 mmHg, and O2 saturations are 97% at rest but drop to 92% on exercise. Blood tests reveal elevated CRP levels. What is the most likely investigation to confirm the diagnosis?

MRCP2-2739

A 28-year-old woman has just come back from a trip to Kenya and is now experiencing a fever (39.8°C), sore throat, lymphadenopathy, and a macular rash that has spread throughout her body.

What is the probable diagnosis?

MRCP2-2740

A 68-year-old woman was admitted to the hospital with a tender, hot, right calf. She had a history of congestive cardiac failure and chronic edema of her left leg. The admitting doctor considered deep vein thrombosis or cellulitis as possible diagnoses and started the patient on low molecular weight heparin while scheduling a Doppler ultrasound scan of the affected leg.

During the night, the nursing staff requested a review of the patient by the senior house officer, as they felt that she was unwell. Upon examination, the SHO noted that the patient was confused, had a fever of 39.0°C, a blood pressure of 85/60 mmHg, a pulse of 120 beats per minute and regular, and a respiratory rate of 32 breaths per minute. The area of erythema on the right lower leg had extended to the mid-thigh.

Given the patient’s acute illness, which of the following is the appropriate course of action?

MRCP2-2741

A 28-year-old pregnant woman presents to the acute medical unit with flu-like symptoms and jaundiced sclera at 26 weeks gestation. She recently returned from a two-week trip to visit family in Bangladesh and had received the hepatitis A vaccine prior to travel. On examination, she has a jaundiced sclera, a blood pressure of 108/60 mmHg, a temperature of 38.1ºC, and a pulse of 96/min. She experiences slight tenderness in the right upper quadrant of her abdomen. Blood tests reveal elevated levels of bilirubin, ALP, ALT, γGT, and CRP, as well as decreased albumin levels. What is the most likely diagnosis?