Archives: MRCP Part 2

MRCP2-2600

A 28-year-old female patient presented with a 10-day history of lower abdominal discomfort that intensified during sexual activity. She also experienced two instances of post-coital vaginal bleeding. Within the past two weeks, she engaged in unprotected sexual intercourse with two male partners. Upon examination, she had a fever of 37.6 °C and experienced bilateral pain during bimanual palpation. The following investigations were conducted: haemoglobin (Hb) level of 126 g/l (normal range: 135 – 175 g/l), white cell count (WCC) of 9.5 × 109/l (normal range: 4.0 – 11.0 × 109/l), and cervical smear showing neutrophils. What is the most probable diagnosis?

MRCP2-2584

A 32-year-old woman presented to the Emergency Department with a 3-day history of loose stools. She had recently returned from a trip to Thailand.
Upon examination, her temperature was 37.1°C, blood pressure 120/80 mmHg, and pulse rate 92 bpm. Her abdomen was soft with tenderness in the lower quadrants. No rashes were present.
Based on the following lab results, what is the most probable cause of her diarrhoea?

s
Haemoglobin (Hb) 129 g/l 120 – 160 g/l
White cell count (WCC) 10.2 × 109/l 4.0 – 11.0 × 109/l
Sodium (Na+) 142 mmol/l 135 – 145 mmol/l
Potassium (K+) 3.6 mmol/l 3.5 – 5.0 mmol/l
Creatinine (Cr) 98 µmol/l 50 – 120 µmol/l
Urea 7.8 mmol/l (2.5–7.0) 2.5 – 6.5 mmol/l
Bilirubin 12.0 µmol/l 1 – 22 µmol/l
Alanine aminotransferase (ALT) 33 u/l 7 – 55 u/l
Alkaline phosphatase (ALP) 85 u/l 30 – 150 u/l
Gamma glutamyl-transferase (GGT) 28 u/l < 50 u/l

MRCP2-2585

A 35-year-old woman presented to the Emergency Department with a 3-day history of abdominal pains and bloody diarrhoea. She had returned from Kenya one week ago. During her 5 weeks stay in Kenya, she was asymptomatic.

On examination, her temperature was 37.8°C. Her abdomen was generally tender to touch but no masses could be felt, and she had active bowel sounds.

Investigations:
Haemoglobin (Hb) – 129 g/l (normal values: 135 – 175 g/l)
White cell count (WCC) – 11.5 × 109/l (normal values: 4.0 – 11.0 × 109/l)
Platelets (PLT) – 320 × 109/l (normal values: 150 – 400 × 109/l)
Sodium (Na+) – 138 mmol/l (normal values: 135 – 145 mmol/l)
Potassium (K+) – 5.2 mmol/l (normal values: 3.5 – 5.0 mmol/l)
Urea – 7.8 mmol/l (normal values: 2.5 – 6.5 mmol/l)
Creatinine (Cr) – 75 µmol/l (normal values: 50 – 120 µmol/l)

What is the most likely diagnosis?

MRCP2-2586

A 25-year-old woman presents with lower abdominal pain, intermenstrual bleeding, contact bleeding, and a purulent vaginal discharge. She recently started a new relationship and was treated for syphilis two weeks ago. What diagnostic tests would you recommend to confirm the diagnosis?

MRCP2-2587

A 16-year-old male presents with a one week history of fever, sore throat, non-productive cough, and headaches. He has developed a skin rash today. His vital signs are stable with a temperature of 38.5ºC, pulse of 90/min, blood pressure of 115/78 mmHg, and respirations of 16/min.

During the examination, his throat appears hyperaemic, but there is no cervical lymphadenopathy. Chest auscultation and percussion are normal. The patient has dusky red, target-shaped skin lesions on all four extremities. A chest x-ray shows interstitial infiltrates in the left lower lobe. Sputum Gram stain reveals polymorphonuclear cells but no organisms.

What is the most likely organism responsible for this presentation?

MRCP2-2588

A previously healthy 27-year-old man presents with abdominal discomfort and shortness of breath. He has been experiencing a dry cough for the past 12 days. He works as a full-time accountant, does not smoke, and drinks approximately 15 units of alcohol per week. He recently went on a trip to Amsterdam with his friends. He has also noticed a widespread skin rash with pink rings around a pale center.

Upon admission, his blood work shows:

– Sodium (Na+): 129 mmol/l
– Potassium (K+): 3.8 mmol/l
– Urea: 8.5 mmol/l
– Creatinine: 155 µmol/l

A chest x-ray reveals diffuse reticular infiltrates and a small left-sided pleural effusion. What is the most likely causative organism?

MRCP2-2589

What is a known complication that can arise from Chlamydia trachomatis?

MRCP2-2590

A 35-year-old woman presents to the Emergency Department with a 4-day history of severe watery diarrhoea after returning from a trip to Thailand two weeks ago. She reports having more than 15 bowel movements per day. Prior to this, she has been healthy with no significant medical history.

Upon examination, she is febrile with a temperature of 38.5°C. Her eyes appear sunken, and she has poor skin turgor. Her heart rate is 120 bpm, and her blood pressure is 90/60 mmHg. Her chest is clear on auscultation, and her heart sounds are regular. She is saturating well on room air. There is diffuse abdominal tenderness, but no guarding or palpable masses.

What is the most common complication associated with this likely diagnosis?

MRCP2-2591

A 29-year-old man presents with cough and fevers. He reports a persistent cough for about 6 months with occasional blood in the sputum. He has also lost around 10 kg in the last 2 months. He migrated to the UK from India about a year ago and denies any contact with tuberculosis patients.

You isolate him in a negative pressure room due to suspected tuberculosis. What test is the most likely to confirm the diagnosis?

MRCP2-2592

A 78-year-old male has been receiving medical care for the past week due to a full sensitive E. coli bacteraemia that was believed to have originated from the urinary system. After completing the treatment, the patient is still in the hospital for physiotherapy. However, the patient experiences a sudden increase in temperature the following day, and cultures reveal the regrowth of E. coli.

What would be the most suitable course of action to take next?