A 35-year-old physician working in the Oncology department arrived at the Emergency Room one hour after experiencing a needlestick injury while on duty. The needlestick injury was caused by a patient who had tested positive for hepatitis B and was receiving entecavir treatment. The physician had been wearing gloves at the time of the injury and had punctured the pad of their right thumb. They had washed the wound with running water immediately after the incident.
Donor virology investigations: Hepatitis B surface antigen (HBsAg) Positive Anti-HBc Positive Anti-HBs Negative HIV RNA PCR Negative
What is the recommended course of action now?
MRCP2-2690
A 35-year-old man returns from a bachelor party in Amsterdam with symptoms of fever, headache, and abdominal pain. He was away for two days and consumed 40-50 units of alcohol. Additionally, he had unprotected sexual intercourse with a local woman and has a vague memory of falling into a canal on the second night. Upon arrival at the emergency department, he is febrile with a blood pressure of 100/70 mmHg. Routine blood tests reveal:
A chest X-ray shows pulmonary hemorrhage. What is the most likely diagnosis?
MRCP2-2691
You are requested to assess a patient suffering from acute respiratory failure caused by H1N1 influenza virus infection. The patient, who is intubated and on a ventilator, has been found to have significant amounts of gastric fluid aspirated from her nasogastric tube. At present, she only has peripheral intravenous access. What would be the most suitable course of treatment for this patient?
MRCP2-2692
A 35-year-old woman presents to the clinic with a 4-month history of fatigue and occasional fevers. She reports frequent respiratory infections and has recently been treated for a vaginal yeast infection. Her medical history includes asthma, which is managed with albuterol as needed. After running some tests, it is discovered that she is HIV positive. She is started on a HAART regimen consisting of lamivudine, tenofovir, and efavirenz. What is the most common adverse effect of lamivudine?
MRCP2-2693
A 58-year-old man who recently returned from a cruise to the Caribbean presents to the emergency department with a fever, cough, and difficulty breathing. He has also been experiencing headaches, abdominal pain, and diarrhea. The patient has a history of type 2 diabetes and a smoking history of 20 pack-years. He does not use alcohol or illicit drugs. On examination, he has crackles in both lungs and appears confused at times. His chest x-ray shows bilateral interstitial infiltrates. Which antibiotic should be administered to this patient?
MRCP2-2695
A 35-year-old male presented to the emergency department with a 5-day history of fever, malaise, myalgia, joint pains, and headache. He thought he was recovering but over the past 2 days, his eyes had started to turn yellow. He had no past medical history and was on no regular medications. He had recently returned from Thailand 8 days ago where he had spent 2 weeks participating in many outdoor activities, including hiking and swimming in rivers. He denied having a regular partner but reported that he had unprotected sexual intercourse on his last night in Thailand. He does not remember being bitten by insects.
On examination, he looked unwell. His observations were as follows: temperature 39.2ºC respiratory rate 20/min heart rate 105 bpm blood pressure 110/70 mmHg SpO2 99% on room air
He had scleral icterus and mild tender hepatomegaly. A faint petechial rash could be seen on his torso, hands, and feet. Blood tests results were as follows:
Which test is most likely to reveal the diagnosis?
MRCP2-2696
A 46-year-old woman presents to the emergency department with cough, haemoptysis, and episodes of epistaxis. Additionally, she reports a two week history of fatigue, fever and muscle aches.
On examination, she appears icteric. Coarse crackles are heard on her chest and she has right upper quadrant tenderness. There is tenderness in both her calves and in her lower back.
She is usually fit and well, working as a teacher in a nearby town. She is a non-smoker and consumes around 15 units of alcohol a week. At home, she has a pet dog.
What is the most appropriate course of action for this patient?
MRCP2-2697
You are asked to see a 55-year-old gentleman due to a raised serum creatinine. He has just been admitted with new onset congestive cardiac failure. He works in a fish farm and has no relevant past medical history. He gives a history of feeling unwell for the last one to two weeks with headaches and muscle aches and pains.
On examination, the patient appears relatively well but has a tinge of jaundice and suffusion of the conjunctivae. He has pitting edema till mid-shin and fine crackles at the lung bases. Pulse is 90 bpm regular and he is afebrile.
The following investigation results are available until the moment of consultation:
A 42-year-old businessman presents to the general medical take with fever, jaundice, and headaches. He recently returned from a business trip to Hong Kong and has been unable to participate in his favorite hobby of river sailing for the past two weeks. On examination, he is tachycardic with a temperature of 39.5°C and appears confused and combative. His chest has scattered crackles bibasally, and he reports right upper quadrant abdominal pain.
Investigations reveal hazy lung infiltrates bibasally, a white cell count of 17.8 × 109/L, a neutrophil count of 15.7 × 109/L, and a platelet count of 413 × 109/L. His serum C-reactive protein is 345 mg/L, serum urea is 13.3 mmol/L, serum total bilirubin is 110 mol/L, serum alanine aminotransferase is 117 U/L, serum alkaline phosphatase is 110 U/L, and serum gamma glutamyl transferase is 61 U/L.
What is the most likely diagnosis?
MRCP2-2699
A 45-year-old man with a prolonged history of alcohol abuse presents with an acute illness. He complains of headache, fever, meningism, and ataxia. An MRI of his brain reveals patchy high signal abnormalities in the brain stem. His CSF analysis shows polymorphonuclear pleocytosis and low glucose levels. Despite receiving three days of intravenous cefotaxime treatment, he has not shown any improvement. What is the probable organism responsible for his condition?