Archives: MRCP Part 2

MRCP2-2666

A 50-year-old homeless man comes in with a persistent cough, occasional coughing up of blood, and weight loss over the past two months. His chest X-ray reveals consolidation in the upper right lobe. After confirming a diagnosis of tuberculosis through microscopy, he is started on a combination of rifampicin, isoniazid, pyrazinamide, and ethambutol, along with pyridoxine supplements. However, after eight weeks, culture results indicate that the Mycobacterium tuberculosis is resistant to isoniazid. What would be the appropriate course of action for his continued treatment?

MRCP2-2667

A 42-year-old woman contacts her doctor for guidance. Four days ago, she had contact with her niece who was sick and had a rash. It has now been confirmed that her niece has measles. The patient is worried as she did not receive the measles vaccine during her childhood. Additionally, she is taking methotrexate for her rheumatoid arthritis.

At present, she does not have any symptoms.

What is the best course of action for treatment?

MRCP2-2668

A 28-year-old nurse arrives at the emergency department as advised by occupational health. She sought advice after being coughed on by a 22-year-old patient who is currently receiving empirical antibiotics for bacterial meningitis. The nurse felt droplets make contact with her face during the incident. She reports feeling well otherwise, with a history of appendicitis and polycystic ovaries but no other medical issues. She takes metformin and oral contraceptives.

The patient in question was admitted 12 hours ago and has since undergone a lumbar puncture which confirmed meningococcal meningitis. What is the most appropriate course of action for the nurse?

MRCP2-2669

A 65 year old man, originally from Russia, presents to the hospital with a right sided pleural effusion, night sweats, and weight loss. He is febrile on admission and his pleural effusion is exudative. A CT scan reveals enlarged lymph nodes in his abdomen and mediastinum. A pleural biopsy confirms Mycobacterium Tuberculosis complex and he is started on treatment. His HIV serology is positive and he is started on anti-retroviral treatment. Three weeks later, he becomes more unwell with daily fevers and abnormal blood results. What is the most likely diagnosis?

MRCP2-2650

A 35-year-old woman who is 28 weeks pregnant and recently returned from a business trip to India presents to the clinic. She has been experiencing nausea, flu-like symptoms, and diarrhea for the past few days and has noticed yellowing of her skin. On examination, her blood pressure is 100/70 mmHg, temperature 38.2 °C, and pulse 90 bpm and regular. Abdominal examination reveals tenderness in the right upper quadrant.
Investigations;
Haemoglobin (Hb) 120 g/l 130–170 g/l
White cell count (WCC) 9.5 × 109/l 4–11 × 109/l
Platelets (PLT) 180 × 109/l 150–400 × 109/l
Sodium (Na+) 138 mmol/l 135–145 mmol/l
Potassium (K+) 4.0 mmol/l 3.5–5.0 mmol/l
Creatinine 95 µmol/l 60–110 µmol/l
Alanine aminotransferase (ALT) 1800 IU/l 5–30 IU/l
Albumin 35 g/l 35–55 g/l
Alkaline phosphatase (ALP) 250 IU/l 30–130 IU/l
Bilirubin 110 µmol/l 2–17 µmol/l
International normalised ratio (INR) 1.1 1.1

She has been vaccinated against hepatitis A and B
What is the most likely diagnosis for this patient?

MRCP2-2651

A 60-year-old woman presents to your clinic with a complaint of vesicles that progressed to scabs on her inner thigh along the L1 dermatome. She reports experiencing a burning sensation along the same dermatome before the vesicles appeared. The vesicles are only present on the left side of her body. What is the probable diagnosis?

MRCP2-2652

You evaluate a 44-year-old male in the Emergency department who presents with mild pleuritic pain and evidence of consolidation on his CXR. Despite his symptoms, his observations are normal and he is a non-smoker. His CURB score is 0.

During the consultation, he discloses that he was diagnosed with HIV five years ago with a CD4 count of 340 cells/μL. He is currently taking truvada and efavirenz, and his HIV was acquired heterosexually. He has been stable with a fully suppressed viral load on antiretrovirals ever since, and his CD4 count is now 600 cells/μL.

What would be your approach to managing his illness?

MRCP2-2653

A 53-year-old intravenous drug user has just been diagnosed with HIV after presenting with progressive shortness of breath. He was diagnosed with pneumocystis pneumonia and started on appropriate treatment.

His CD4 count is 54 cells/mm3, and his viral load is 1.7 x10^7 copies per ml. As part of his routine workup, it is also discovered that he has co-infection with hepatitis C. A test for HIV viral tropism reveals a dual tropism virus.

Which medication is unlikely to be effective in treating this man’s condition?

MRCP2-2654

You receive a call from a nurse in the occupational health team who informs you that a young doctor on the ward has suffered a needle stick injury from one of your patients. The doctor has been vaccinated against hepatitis B virus, but is worried about the risk of contracting HIV from the injury.

The patient in question is a 27-year-old man who has a history of poorly controlled epilepsy for the past 9 years and has been admitted to the hospital multiple times due to this condition. He lives with his wife and works as a caretaker. He was admitted to the hospital due to severe nausea and vomiting and has been unable to take his medication. After admission, he developed status epilepticus and has been anaesthetised, ventilated and transferred to the intensive care unit where he remains unconscious. His HIV status is unknown.

The nurse requests that you perform an HIV test on the patient to determine whether post-exposure prophylaxis (PEP) is necessary. What is the best course of action in this situation?

MRCP2-2655

A 45-year-old man presented to the Emergency department with a one week history of mild global headache. He had difficulty expressing himself verbally on the day of admission and experienced a generalised seizure in the ambulance on the way to the hospital. Upon examination, he was fully conscious with a Glasgow coma scale score of 15/15. He had a fever (38°C) with a pulse of 80 beats per minute in sinus rhythm and blood pressure of 130/75 mmHg. There was no nuchal rigidity, but he had an expressive dysphasia and mild right-sided weakness. An MRI scan of his brain showed abnormal signals in both temporal lobes, with the left side showing a degree of mass effect. A lumbar puncture was performed, and CSF analysis showed normal opening pressure, protein, and glucose levels, with 9 lymphocytes/mm3 cells and a negative gram stain. What is the most likely diagnosis?