Archives: MRCP Part 2

MRCP2-2722

A 35-year-old woman is undergoing her second round of chemotherapy for breast cancer. She is experiencing two days of vomiting and watery diarrhoea, accompanied by occasional chills and weakness. She has not traveled abroad and has not been in contact with anyone who is ill. Her husband is a farmer, and they recently attended a farm foods show that featured local cheese and meats in the area.

During the examination, the woman’s abdomen is soft, with mild tenderness in the right iliac fossa. She has dry mucosa and muscle aches throughout her body.

Hb 110 g/l Na+ 138 mmol/l
Platelets 348 * 109/l K+ 3.9 mmol/l
WBC 2.4 * 109/l Urea 4.3 mmol/l
Neuts 0.7 * 109/l Creatinine 76 µmol/l
Lymphs 1.4 * 109/l CRP 96 mg/l

The stool specimen reveals a gram-positive bacillus. What is the likely causative organism in this case?

MRCP2-2723

A 54-year-old male with acute lymphoblastic leukaemia is on his third cycle of chemotherapy. He is admitted to the ward after developing a temperature of 38.7ºC before his fourth cycle. He feels well in himself but has ongoing trouble with diarrhoea and mucositis. Currently, his stools are type four on the Bristol stool chart and his mouth ulcers are being treated with a lidocaine/nystatin topical solution. He denies any cough, sore throat or urinary symptoms.

During examination, his abdomen is soft and non-tender with normal bowel sounds. His chest is clear with air entry heard throughout. He has no murmurs, joint effusions or areas of cellulitis. His mouth contains multiple ulcers with areas of straw colored exudate overlying them.

Hb 110 g/l
Platelets 60 * 109/l
WBC 1.1 * 109/l
Neuts 0.5 * 109/l

Blood culture (1st) Staphylococcus epidermidis
Blood culture (2nd) no growth
Chest X-ray clear lung fields, normal cardiac contour
Nasopharyngeal PCR negative
Urine dip negative for leucocytes and nitrites

What investigation would be the most effective in identifying the cause of the fever?

MRCP2-2724

A 42-year-old man with poorly controlled type 1 diabetes mellitus presents with a nodular lesion on the left-side of his face around the angle of the jaw. Two months ago he had a tooth extraction at the dentist. The nodule is around 2 cm in diameter, raised and purple-red in colour. On examination a sinus tract is seen in the middle of the nodule which is draining a blood-stained fluid.

Microscopy of the discharge shows microscopic yellow granules.

What is the most likely causative organism?

MRCP2-2725

A 65 year old male who is a malnourished alcoholic presents with a chronic cough for the past 6 weeks associated with a low grade fever. The cough is productive of purulent sputum.

Six months previously he had been diagnosed with early stage non-Hodgkin’s lymphoma, which had responded well to chemotherapy (doxorubicin, bleomycin, vinblastine, and prednisolone).

On examination his temperature is 37.8ºC, blood pressure 140/80 mmHg, and his pulse is 96/minute and regular. Auscultation of the chest reveals absence of breath sounds over the left middle lung field. Chest x-ray confirms left upper lobar consolidation.

The following investigations were ordered:

Hb 12 g/dl
Platelets 180 * 10^9/l
WBC 7 * 10^9/l
MCV 85 fl
Na+ 140 mmol/l
K+ 5 mmol/l
Creatinine 90 µmol/l
Urea 5 mmol/l
CRP 50 mg/l

Sputum stains partially acid fast bacilli with branching rods

What is the most appropriate initial treatment plan for this patient?

MRCP2-2726

A 52-year-old businessman who frequently travels to the Gambia and is usually diligent with his malaria prophylaxis presents with general malaise and relapsing/remitting fevers occurring every third day. He returned from the Gambia a week ago and did not take his malaria prophylaxis as he has never contracted the disease before. He has no significant medical history and takes no regular medication. The thick and thin films reveal malarial parasites, which are confirmed as Plasmodium vivax by the Malaria Reference Laboratory. What is the most appropriate management in accordance with current UK guidelines?

MRCP2-2727

A 25-year-old patient presents to the clinic with a six-month history of malaise, anorexia, and weight loss. Additionally, he reports experiencing diarrhea for the past four weeks. Upon examination, the patient appears cachectic and has white frond-like patches on both lateral margins of his tongue. Scraping off the patches proves to be unsuccessful. What is the organism responsible for this abnormality on the patient’s tongue?

MRCP2-2707

A 32-year-old single woman presents with her third episode of left iliac fossa pain in the past six months. She has also noticed irregular bleeding between periods and has been experiencing occasional mucopurulent discharge from her cervix, although there are no visible sores. During the examination, she reports lower abdominal pain that is more severe on the left side. The abdomen is soft, and there is no rebound tenderness. Urine and pregnancy tests are negative.
What is the most appropriate next step in managing this patient’s likely diagnosis?

MRCP2-2710

A 15 month-old Syrian boy is brought to the health centre by his father. They are living in a Lebanese refugee camp after fleeing violence in their country. He has a widespread maculopapular rash that first affected the face before spreading to the torso and limbs. On examination, he has a cough, rhinorrhoea and conjunctivitis bilaterally. White spotting is seen on his buccal mucosa. The father reports that his other children have had similar symptoms.

What is the most appropriate treatment for this patient?

MRCP2-2711

In several medical facilities, around 40% to 50% of the Staphylococcus aureus isolates exhibit methicillin resistance.

What causes methicillin resistance in Staphylococci?

MRCP2-2712

A 49-year-old male with hepatitis C presents to the acute medical assessment unit with a recent decrease in urine output. Upon urinalysis, haematoproteinuria is detected, and the following blood results are obtained:

– Hb: 9.8 g/dl
– Platelets: 75 * 109/l
– WBC: 12.1 * 109/l
– Na+: 143 mmol/l
– K+: 5.4 mmol/l
– Urea: 18.9 mmol/l
– Creatinine: 205 µmol/l

After a renal biopsy, the sample is examined under a microscope and reveals enlarged and hypercellular glomeruli with an increase in mesangial cellularity and matrix. The histological diagnosis is membranoproliferative glomerulonephritis. What is the most likely underlying pathology for this finding?