Archives: MRCP Part 2

MRCP2-2601

A 45-year-old businesswoman recently returned from a four-day trip to Mexico for work. She began experiencing symptoms five days after returning to the United Kingdom, including fever, headache, eye pain, back pain, and severe muscle pain. She also developed a rash that started on her trunk and spread to her extremities and face. Upon examination, she appeared ill and had a temperature of 38°C and blood pressure of 120/70 mmHg. She had swollen adenoids with palatal vesicles and a maculopapular rash all over her body. What diagnostic tests would you recommend to confirm the diagnosis?

MRCP2-2602

A 29-year-old man with a medical history of HIV and poor medication compliance presents to the Emergency Department with symptoms of fever, shortness of breath, weight loss, and diarrhea. On examination, he has general lymphadenopathy, tender hepatosplenomegaly, and bilateral basal crackles on chest auscultation. His laboratory results show low hemoglobin, white cell count, and platelets, as well as a severely decreased CD4 count. His liver function tests are also abnormal. What is the most probable diagnosis?

MRCP2-2603

A 28-year-old female patient comes in with a complaint of a thin, white discharge with a fishy odor that is particularly noticeable after sexual intercourse. Upon examination with a saline wet mount, clue cells are detected. What is the diagnosis?

MRCP2-2604

A 33-year-old woman presents to the Emergency Department with a three-day history of severe headache, stiff and painful neck, photophobia, and fever. She moved to the UK from India 10 years ago and has been living in the area for three years. She works as a medical coder in the hospital and has no significant medical history except for groin lymphadenopathy that was investigated five years ago. Her husband reports that she has been drowsy and confused since that morning.

Investigations reveal a high CRP level, elevated white cell count, and turbid cerebrospinal fluid with high protein and low glucose levels. The CSF gram stain and PCR results are pending.

What is the recommended treatment regimen for this patient?

MRCP2-2605

An 18-year-old man presents to the Immunology Clinic with a history of multiple infections over the past year, including two episodes of otitis media, three episodes of pneumonia, and one episode of Campylobacter infection. He admits to engaging in unprotected sexual intercourse with other men on two occasions in the past two years. On examination, his vital signs are within normal limits, and there is no lymphadenopathy. His BMI is 23. Laboratory investigations reveal low levels of IgG and IgA, as well as elevated CRP and ESR. Based on these findings, what is the most likely diagnosis?

MRCP2-2606

A 68-year-old man visits his GP in the UK. He is originally from Southern India and is visiting his son. His family has brought him to the doctor as he is experiencing clawing of his fingers and inability to extend his wrist. During examination, a dry scaling rash is observed above the elbow on the affected side. The skin rash is painless and non-itchy, and there is evidence of sensory loss distal to the lesion. What is the most probable diagnosis in this scenario?

MRCP2-2607

A 32-year-old woman with HIV presents to clinic with complaints of tiredness, abdominal discomfort, and urinary frequency for the past two months. Despite a course of trimethoprim prescribed by her general practitioner 10 days ago, her symptoms have not improved. She has been on antiretroviral therapy for six months and is currently taking Atripla. Her latest HIV viral load was undetectable, and her CD4+ count was 450. She has been amenorrhoeic for the past two years due to her contraceptive implant. Blood tests reveal abnormal liver function tests. What investigation would be most helpful in confirming the diagnosis?

MRCP2-2608

A 19-year-old male presents with a six week history of generalised pruritus which is also interrupting his sleep. His symptoms began shortly after returning from a holiday on the Greek island of Mykonos.

Examination reveals a normal temperature, he has a pulse of 70 beats per minute and a blood pressure of 110/78 mmHg. Examination of the skin reveals tiny erythematous papules in the finger webs but nil else.

Investigations revealed:

Hb 135 g/L (130-180)
White cell count 5.5 ×109/L (4-11)
Platelets 320 ×109/L (150-400)
Electrolytes Normal
Alkaline phosphatase 90 U/L (45-105)
AST 22 U/L (1-31)
Bilirubin 10 µmol/L (1-22)
ESR 12 mm/hr (0-10)

Which investigation would you request next?

MRCP2-2609

A 35-year-old intravenous drug user, who is not on any medication, presents with several weeks of fever, dyspnea, night sweats, weight loss, and a non-productive cough. Physical examination reveals dry rales, and chest radiography shows diffuse interstitial infiltrates. Upon further investigation, the patient is found to be HIV-positive with a CD4 cell count of 95 cells/mm3. Pneumocystis carinii is not detected in induced sputum. What diagnostic test would you perform to confirm the diagnosis?

MRCP2-2610

As an infectious disease expert with the World Health Organisation, I am faced with the challenge of updating guidelines on the first line treatment of severe malaria. However, there is a division of expert opinion regarding the recommendation of a new drug. In this scenario, what type of study would be appropriate for me to undertake?