Archives: MRCP Part 2

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:

– Haemoglobin 140 g/L (130-180)
– WCC 15.1 ×109/L (4-11)
– Neutrophils 12.0 ×109/L (1.5-7)
– Lymphocytes 3.1 ×109/L (1.5-4)
– Platelets 180 ×109/L (150-400)
– ESR 120 mm/hr (0-20)
– Serum sodium 130 mmol/L (137-144)
– Serum potassium 5.8 mmol/L (3.5-4.9)
– Serum urea 7.0 mmol/L (2.5-7.5)
– Serum creatinine 500 µmol/L (60-110)

What is the most probable diagnosis?

MRCP2-2698

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?

MRCP2-2700

A 40-year-old woman, who has just been diagnosed with HIV, is planning to travel the world and has come to the clinic to ask about the vaccinations she needs. Her CD4 count is currently 200, but she has decided not to start HAART until after her trip. Which vaccinations can she safely receive?

MRCP2-2670

A 15-year-old, unvaccinated child is brought into the emergency department after possible exposure to measles. The child has juvenile arthritis well controlled on methotrexate but is otherwise well with no other medical issues. His mother explains that the child attended a large party 2 days previously and she received a call this morning informing them that another child who attended the party has just been diagnosed with measles. She has no further information regarding the other child or as to whether they were symptomatic etc.

The 15-year-old reports no symptoms currently and appears well in the emergency department. His examination is unremarkable and observations are as follows:

Heart rate 95 beats per minute
Blood pressure 118/78 mmHg
Respiratory rate 18 breaths per minute
Oxygen saturations 99%
Temperature 36.5 ºC

What is the most appropriate management option?

MRCP2-2671

A 58-year-old male is being discharged from hospital after being treated for pneumonia.

All the clinical signs and symptoms are normal on discharge, but he is a smoker.

When would you like to review him and his chest radiograph after discharge?

MRCP2-2672

You are working in a pediatric admissions unit.
Following the British HIV Association guidelines, which of the following conditions should prompt you to consider performing an HIV test?

MRCP2-2673

A 36-year-old woman visits her HIV clinic for her routine check-up, having undergone her regular blood tests two weeks prior to her appointment. She was diagnosed with HIV six years ago and has been stable on antiretroviral therapy since then. She also has asthma, which is well-managed. She reports good adherence to her medications, but unfortunately missed two doses while on a weekend getaway. She feels generally healthy.

Lab Results:
Today Two weeks ago One year ago
HIV viral load 110 copies/ml <50 copies/ml <50 copies/ml
CD4 count 983 cells/mm3 912 cells/mm3 Not tested

What further investigations should be conducted for this patient?

MRCP2-2674

A 33-year-old woman of Nigerian descent attends the HIV clinic. She has been under the care of the HIV service for the past 8 years since arriving in the UK. Currently, she is taking dolutegravir, emtricitabine, and tenofovir and is highly compliant with her medication. She is feeling well and excited as she is 16 weeks pregnant, her first pregnancy. Although she experienced some vomiting earlier in the pregnancy, she is now doing fine. Her blood test results show a CD4 count of 0.84×10^9/L, CD8 count of 1.01×10^9/L, and a viral load of <20 RNA/ml. She has come to discuss the management of her HIV with you. What is the most appropriate management plan for this patient?