Archives: MRCP Part 2

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?

MRCP2-2708

A 28-year-old pregnant woman visits her doctor with concerns about her potential exposure to chickenpox at a family gathering she attended two days ago. She reports no prior history of chickenpox and is anxious about the potential impact on her unborn child. She is currently feeling well and has no notable symptoms.

Upon examination, her vital signs are within normal limits. Her lungs are clear and her heart sounds regular. Her abdomen is soft, and her uterus is palpable, consistent with 22 weeks of gestation.

What is the most appropriate course of action for this patient?

MRCP2-2709

A 30-year-old male has just been diagnosed with HIV and his CD4 count is 53 cells/μL. He underwent testing for Hepatitis B and the results are as follows: Hep B eAg negative, Hep B eAb positive, and Hep B sAg positive. Determine which statement is true based on this information.

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?

MRCP2-2713

A 34-year-old gay man presented to the hospital complaining of dyspnoea, dry cough and fever that had been progressively worsening over the past four weeks. Upon examination, his chest x-ray revealed bilateral diffuse airspace shadowing and bronchial washings showed the presence of Pneumocystis jirovecii. His CD4 T-lymphocyte count was found to be 88 cells/mm3 and he had a history of rash with co-trimoxazole. Treatment for Pneumocystis jirovecii pneumonia was initiated with trimethoprim and dapsone, which resulted in improvement within 24 hours. However, five days later, he became increasingly breathless and cyanosed, with oxygen saturations measured at 85% by pulse oxymetry and a PaO2 of 12.1 kPa (11.3-12.6). What is the most appropriate immediate course of action?

MRCP2-2714

A 25-year-old man presents to the emergency department with a fever and shortness of breath. He has a past medical history of type 1 diabetes and has had a recent hospital admission with diabetic ketoacidosis. He now has an insulin pump. He does not smoke or drink alcohol.

Observations:
Heart rate 120 beats per minute
Blood pressure 92/48 mmHg
Respiratory rate 22/minute
Oxygen saturations 94% on room air
Temperature 38.4C

On examination, he appears diaphoretic and unwell. Chest auscultation reveals coarse crackles at the right base.

Blood tests:

Hb 138 g/L Male: (135-180)
Female: (115 – 160)
Platelets 189 * 109/L (150 – 400)
WBC 14.7 * 109/L (4.0 – 11.0)
Na+ 138 mmol/L (135 – 145)
K+ 4.2 mmol/L (3.5 – 5.0)
Urea 8.2 mmol/L (2.0 – 7.0)
Creatinine 99 µmol/L (55 – 120)
CRP 221 mg/L (< 5) A chest -ray demonstrates consolidation in the right lower zone. He is commenced on empirical broad-spectrum antibiotics to treat sepsis secondary to pneumonia. At 24 hours, a blood culture grows Klebsiella pneumoniae , which is identified as producing carbapenemase. What is the most appropriate antibiotic choice?

MRCP2-2701

A 35-year-old man presented with a 4-week history of oedema and occasional tingling in his right leg. He had experienced painful muscle cramps in his legs and abdomen 3 months ago and had noticed swelling and numbness in his right leg. He had traveled to Thailand 10 months ago and had significant exposure to fresh water during his trip. On examination, he had a non-tender hepatomegaly of 4 cm without splenomegaly. Papular erythematous lesions were present on both legs, and there was pitting oedema in his right lower leg. Sensation to light touch over the right lower leg was reduced. The following results were obtained from his investigations:
White cell count (WCC) 14.8 × 109/l 4.0 – 11.0 × 109/l
Lymphocytes 3.5 × 109/l 1.5 – 4.0 × 109/l
Neutrophils 6.2 × 109/l 1.5 – 7.0 × 109/l
Eosinophils 5.1 × 109/l 0.04 – 0.4 × 109/l
Haemoglobin (Hb) 142 g/l 115 – 160 g/l
Platelets (PLT) 320 × 109/l 150 – 400 × 109/l

What is the most probable diagnosis?

MRCP2-2702

A 30-year-old Indian woman presented to the clinic with a history of a large swelling on her right leg for over four years, accompanied by fever and groin pain. The swelling did not reduce at night. Upon examination, her entire leg was swollen and bluish in color, with a deep skin fold at the junction of the middle and lower third, and a non-discharging sinus above the fold anteriorly. There were no nodules or warts on her limbs.

Hb: 144g/l (130 – 180)
Platelets: 310 * 109/l (150 – 400)
WBC: 9.2 * 109/l (4.0 – 11.0)
Neutrophil: 3.5 * 109/l (1.5 – 7.0)
Lymphocyte: 2.1 * 109/l (1.5 – 4.0)
Eosinophil: 2.4 * 109/l (0.04 – 0.4)
Monocyte: 1.1 * 109/l (0<0.8) What is the drug of choice for the most likely diagnosis in this case?