Archives: MRCP Part 2

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?

MRCP2-2742

A 29 week pregnant woman presents to her GP with a rash that has developed over the past 12 hours. Upon examination, lesions indicative of chickenpox are observed. The patient’s vital signs are stable and she appears to be in good health.

What course of action would be advised for management of this condition?

MRCP2-2715

A 29-year-old construction worker was referred to the hospital by his primary care physician. He had visited the doctor a week ago, complaining of malaise, headache, and myalgia for three days. Despite being prescribed amoxicillin/clavulanic acid, his symptoms persisted and he developed a dry cough and fever. At the time of referral, he was experiencing mild dyspnea, a global headache, myalgia, and arthralgia. Upon examination, he appeared unwell, had a fever of 39°C, and had a maculopapular rash on his upper body. Fine crackles were audible in the left mid-zone of his chest, and mild neck stiffness was noted.

The following investigations were conducted:
– Hb: 84 g/L (130-180)
– WBC: 8 ×109/L (4-11)
– Platelets: 210 ×109/L (150-400)
– Reticulocytes: 8% (0.5-2.4)
– Na: 129 mmol/L (137-144)
– K: 4.2 mmol/L (3.5-4.9)
– Urea: 5.0 mmol/L (2.5-7.5)
– Creatinine: 110 µmol/L (60-110)
– Bilirubin: 27 µmol/L (1-22)
– Alk phos: 130 U/L (45-105)
– AST: 54 U/L (1-31)
– GGT: 48 IU/L (<50) Additionally, a chest x-ray revealed patchy consolidation in both mid-zones. What is the most likely cause of his symptoms?

MRCP2-2716

A 29-year-old electrician was referred to the hospital by his general practitioner. He had visited his GP a week ago, complaining of malaise, headache, and myalgia for the past three days. Despite being prescribed amoxicillin/clavulanic acid, his symptoms persisted and he developed a dry cough and fever. On the day of referral, he reported mild dyspnea, a global headache, myalgia, and arthralgia. During the examination, a maculopapular rash was observed on his upper body, and fine crackles were audible in the left mid-zone of his chest. Mild neck stiffness was also noted. His vital signs showed a fever of 39°C and a blood pressure of 120/70 mmHg.

The following investigations were conducted:
– Hb: 84 g/L (130-180)
– WBC: 8 ×109/L (4-11)
– Platelets: 210 ×109/L (150-400)
– Reticulocytes: 8% (0.5-2.4)
– Na: 137 mmol/L (137-144)
– K: 4.2 mmol/L (3.5-4.9)
– Urea: 5.0 mmol/L (2.5-7.5)
– Creatinine: 110 µmol/L (60-110)
– Bilirubin: 19 µmol/L (1-22)
– Alk phos: 130 U/L (45-105)
– AST: 54 U/L (1-31)
– GGT: 48 U/L (<50) The chest x-ray revealed patchy consolidation in both mid-zones. What is the most appropriate course of treatment?

MRCP2-2717

A 25-year-old carpenter arrives at the Emergency department with a hot and erythematous patch on the back of his hand. The erythema rapidly spreads up his arm and he begins to feel unwell. Urgent debridement in theatre is scheduled. What antibiotics should be administered, assuming no allergies?

MRCP2-2718

A 50-year-old man presents with a fever, pain, and erythema across his abdomen. He had undergone an elective repair of an umbilical hernia 10 days ago and was discharged home. He has a history of type 2 diabetes mellitus and a high body mass index of 31 kg/m² (normal range 18.5 – 24.9kg/m²).

He had been feeling well until the morning of presentation when he noticed a small area of erythema and tenderness around the incision site near his umbilicus. Throughout the day, the erythema grew and became more painful, prompting his wife to bring him to the Emergency Department.

On examination, he appeared unwell with the following vital signs:
temperature 38.6ºC
respiratory rate 23 breaths/min
oxygen saturation 97% on air
heart rate 125 bpm
blood pressure 88/61 mmHg

He complained of severe abdominal pain and nausea, with one episode of vomiting. There was a large area of erythema across the lower half of his abdomen which was extremely tender to palpation. Examination of the erythematous area also revealed impaired sensation to light touch.

His blood results showed:
WBC 17 * 109/L (4.0 – 11.0)
CRP 460 mg/L (< 5) What is the most likely cause of this patient’s infection?

MRCP2-2719

A 20-year-old female patient complains of sudden and intense pain in her left iliac fossa. During the examination, her body temperature is found to be 38.0°C. On pelvic examination, there is tenderness in the uterus and left adnexa. The cervical exudates show Gram-negative intracellular diplococci on Gram staining. What can be inferred from these findings?

MRCP2-2720

A 50-year-old man presents to the Emergency Department with extensive bruising around his hip and bony tenderness after falling onto his left hip while drinking at home. Despite no fracture or bony abnormality being found on his hip x-ray, several 2x4mm specs of calcification are visible in his psoas and thigh muscles.

During a confidential conversation with his wife, she reveals that her husband’s personality has gradually changed over the past year and he is sometimes forgetful. He lost his job as an engineer 3 months ago after working for 8 years on a project in Peru in his thirties. He drinks 8 units of alcohol per day and has had a low mood for several years.

Yesterday, he lost consciousness and had a jerking of his arms and legs lasting 1 minute after hitting his hip on a coffee table and wetting himself. He felt tired and lethargic but refused to go to the hospital. What is the most likely diagnosis?

MRCP2-2721

A 25-year-old intravenous drug user presents with bilateral groin abscesses.

After the abscesses are drained, the patient is prescribed intravenous flucloxacillin and gentamicin. However, 12 hours later, the patient complains of diplopia which worsens, and also experiences dysphagia and muscle weakness, requiring ventilatory support.

What is the likely diagnosis?