Archives: MRCP Part 2

MRCP2-2616

A 30-year-old female patient arrived at the Emergency Department complaining of lower abdominal pain and vomiting that had been going on for a day. She reported having normal bowel movements. Upon examination, her blood pressure was 140/80 mmHg and her temperature was 37.9oC. Her abdomen was tender in both iliac fossae, but soft. Digital rectal examination revealed anterior tenderness, and speculum examination showed tenderness and profuse white-yellow vaginal discharge. A pregnancy test came back negative. What is the most probable diagnosis?

MRCP2-2617

A 35-year-old intravenous drug user has been experiencing back pain for the past six months. Recently, he noticed a deformity in his back and has been feeling unwell. He also claims that his clothes no longer fit him properly. Upon examination, he appears slightly wasted and has a kyphosis in the thoracic area. Laboratory results show a WBC count of 9100 cells/mm3 (within the normal range of 4000-11000 mm3) and an ESR of 40 mm/hr (above the normal range of 20 mm/hr). The radiograph reveals well-maintained disc spaces with erosion of the T7 vertebral body and fusiform swelling from T6-T8. What is the most likely diagnosis?

MRCP2-2618

A 33-year-old man came to the clinic complaining of general malaise, lethargy, and difficulty swallowing with occasional regurgitation of undigested food for the past 6 months. He had been working as a relief worker in Bolivia for 6 years. During the examination, his blood pressure was 110/70 mmHg, his pulse was 95 bpm, and his jugular venous pulse was elevated. Bilateral basal inspiratory crackles were heard on chest auscultation, and he had bilateral pitting leg edema. A dilated esophagus was seen on a barium swallow. What is the most likely organism responsible for his symptoms?

MRCP2-2619

A 35-year-old male, who is the cousin of the British High Commissioner in Nairobi, Kenya, visited his cousin for a two-week vacation about six months ago. He was prescribed mefloquine for malaria prophylaxis but failed to complete the medication. He now presents with symptoms of fever, chills, rigors, and headaches. You suspect malaria and send his blood samples to the laboratory. The thick blood smear reveals large parasites with fragmented cytoplasm, while the thin film shows amoeboid parasites with Schuffner’s nodes in enlarged red blood cells. Which malarial parasite is most likely causing his illness?

MRCP2-2620

A 60-year-old man with a history of alcohol dependence and hypercholesterolaemia is admitted to the Respiratory Ward due to high fevers, myalgia, nausea, and vomiting for the past 10 days. His condition has worsened over the last four days, with increasing shortness of breath and pleuritic chest pain. On examination, he has a temperature of 39.2 °C, a heart rate of 126 bpm, and a blood pressure of 155/93 mmHg. Coarse crackles are heard at the left base of his lungs, and he is saturating at 94% on 6 litres of oxygen by Venturi mask. Investigations reveal abnormal results, including a white cell count of 17.7 × 109/l, neutrophils of 15.1 × 109/l, and a C-reactive protein level of 194 mg/l. A chest X-ray shows left mid-zone consolidation. Given this presentation, what is the most likely causative organism?

MRCP2-2621

A 25-year-old woman presents to the Emergency Department with a severe throat pain. She recently returned from a trip to Southeast Asia. She feels extremely tired, has a high fever, and is having difficulty swallowing. Her vital signs are as follows: temperature 38.5 oC, blood pressure 110/70 mmHg, and pulse 80 bpm and regular. Upon examination, a grey pseudomembrane is observed on the back of her throat.

What is the most crucial initial test for this patient?

MRCP2-2622

A 28-year-old woman presents to the Emergency Department with a painless ulcer on her labia. She admits to having unprotected sexual intercourse with a new partner some two weeks earlier. There is no other significant medical history.
On examination, a single oval, painless ulcer is observed, surrounded by a bright red margin. The base is clean and it is discharging clear serum. Dark field microscopy of ulcer fluid demonstrates spirochaetes. She has a history of allergy to penicillin.
What is the most appropriate choice of antibiotic?

MRCP2-2623

A 27-year-old woman presents to the Emergency Department with a one week history of cough, fever and headache. She returned from Thailand one week ago.

On examination she appears drowsy and a little confused. She has no sensitivity to light or focal neurological deficit. She has mild hepatosplenomegaly but no palpable lymphadenopathy. Her chest is clear and heart sounds are normal. She has a macular rash on both arms with a greyish-black scab-like lesion on her right forearm.

Investigations results:

Chest x-ray: Bilateral patchy consolidation

Blood culture: Pending

Hb 118 g/l
Platelets 135 * 109/l
WBC 19 * 109/l
Blood film Left shifted neutrophils in large numbers

Na+ 140 mmol/l
K+ 4.2 mmol/l
Urea 5.5 mmol/l
Creatinine 88 µmol/l

Bilirubin 20 µmol/l
ALP 175 u/l
ALT 48 u/l
Albumin 36 g/l

What is the most appropriate initial treatment?

MRCP2-2624

A 25-year-old female presents with fever, myalgia, rash, and headache after returning from a trip to Sao Paulo. She reports experiencing fevers and abdominal pain the day before her flight home and developing the rash within the last 24 hours. During the examination, petechiae and a maculopapular rash are observed on her wrists, ankles, and palms, along with a single itchy, erythematous raised papule with a central punctum on her right calf. She suspects a tick bite. What is the most appropriate treatment for the likely diagnosis?

MRCP2-2625

A 28-year-old man presents to his first HIV clinic appointment. He has routine three month HIV tests. He received contact tracing notification last week and was tested and found to be HIV positive. He has just started antiretroviral treatment.

During the appointment, he expresses concern about his upcoming travel plans to South America and whether his new HIV diagnosis will affect his ability to receive necessary vaccinations. He understands that he is currently immunosuppressed and at risk of infections, but is committed to taking his medication as prescribed.

The following are his laboratory results:
– Hemoglobin: 115 g/L (130-180)
– White blood cell count: 6.8 10^9/L (4.0-11.0)
– Neutrophil count: 5.2 10^9/L (1.5-7.0)
– Platelet count: 175 10^9/L (150-400)
– CD4 count: 200 cells/mm3 (600-1500)

Which of the travel vaccinations is safe for him to receive?