A 35-year-old man presents to the medical admissions unit with joint pain and swelling in his hands and feet. He had recently traveled to Colombia and developed an illness characterized by fever, headache, rash, and debilitating polyarthralgia. Mild hepatomegaly was noted by his treating physicians. Despite recovering well from the illness, he continues to experience musculoskeletal symptoms. On examination, he has small joint polyarthritis in his hands and feet, and his abdominal examination is unremarkable. Serological testing reveals positive results for an RNA virus. What is the most likely diagnosis?
MRCP2-2572
A 29-year-old female patient visits the genitourinary medicine clinic complaining of dysuria and vaginal discharge that has been present for four days. She has no medical history and is not taking any regular medications. The patient had unprotected sexual intercourse with a casual partner two weeks ago.
During the speculum examination, the healthcare provider observed cervicitis and clear vaginal discharge. The genitalia examination was otherwise unremarkable. The nucleic acid amplification test confirmed the causative organism.
What is the likely organism responsible for the patient’s symptoms, and what treatment is prescribed?
MRCP2-2573
A 51-year-old patient with end-stage renal failure due to adult polycystic kidney disease is admitted to the Intensive Care Unit with suspected line sepsis from an indwelling permacath. The patient has a history of being MRSA positive from nasal screening swabs.
What is the recommended antibiotic treatment for this patient’s condition?
MRCP2-2574
A 30-year-old man presented with fever 2 weeks after returning from Thailand. His fevers followed a specific pattern, rising over the course of the day and then dropping by the next morning. He also had non-specific abdominal pain, malaise and a dry cough. He had noticed a rash on his arms. On examination, his temperature was 38.5 °C and he appeared dehydrated. He had diffuse abdominal tenderness and a red maculopapular rash over his arms. Investigations:
Haemoglobin 130 g/l 120–160 g/l White cell count (WCC) 10.5 × 109/l 4–11 × 109/l Platelets 180 × 109/l 150–400 × 109/l Sodium (Na+) 137 mmol/l 135–145 mmol/l Potassium (K+) 4.2 mmol/l 3.5–5.0 mmol/l Creatinine 125 µmol/l 50–120 µmol/l Stool culture Isolates of Campylobacter jejuni The patient is reluctant to be admitted to hospital. What is the most appropriate treatment option?
MRCP2-2575
A 47-year-old woman of African descent presents to your clinic with a history of being treated for pulmonary tuberculosis for two weeks with RHZE. She has also tested positive for HIV with a CD4+ count of 50 cells/mm3, CrCl of 40 mg/m2, and ALT and AST levels within normal range. On examination, the patient appears wasted and slightly anemic with an Hb level of 80 g/L. There are no other significant findings.
What would be your recommended HAART regimen for this patient?
MRCP2-2576
A 21-year-old female is worried after being exposed to meningococcal meningitis. Her roommate was diagnosed with the disease and she is seeking preventative treatment.
The patient has no significant medical history and only takes Logynon for contraception and uses a salbutamol inhaler occasionally.
What prophylactic antimicrobial therapy would you recommend in this case?
MRCP2-2577
A 25-year-old traveler who has been exploring India presents with symptoms of severe influenza after visiting crowded markets and staying in local hostels. It is known that there have been recent cases of H5N1 influenza in the area. On examination, the patient is pyrexial with a temperature of 39°C and has severe shortness of breath with crackles in both lung fields. Investigations reveal patchy consolidation through both lung fields on chest X-ray and elevated creatinine levels. What is the most appropriate treatment for this patient?
MRCP2-2578
An 80-year-old woman presents to the hospital with a one week history of malaise, fever, and cough. She reports increasing dyspnea and left-sided chest pain over the past two days, with thick yellow sputum production. Her medical history includes type 2 diabetes mellitus controlled by diet, as well as a previous diagnosis of left breast carcinoma treated with partial mastectomy and radiotherapy. Two months ago, she developed back pain and a lump in the mastectomy scar, for which she received additional radiotherapy. She lives with her husband who has mild dementia, is a non-smoker, and does not drink alcohol. On examination, she is dyspneic at rest, mildly confused, and has reduced breath sounds and coarse crackles at the left base. Her chest X-ray shows left basal consolidation. Laboratory tests reveal a low hemoglobin level, high white blood cell count, and high platelet count. She is treated with amoxicillin/clavulanate and discharged, but readmitted five days later with abdominal pain and fever. On examination, she has a globally tender abdomen and clear chest sounds, but her laboratory tests show an elevated white blood cell count and platelet count, with some increased left basal shadowing on chest X-ray. What antibiotics should be started for this patient?
MRCP2-2579
A 68-year-old man presented to the clinic with profuse diarrhoea lasting for one week, with up to seven bowel movements per day. He reported seeing blood in his stools for the past two days and experiencing general abdominal pain, but no vomiting. His medical history includes gastritis, asthma, and type 2 diabetes mellitus, for which he takes omeprazole. He recently returned from a two-week seaside vacation and had received a short course of clindamycin from his GP for cellulitis before the trip. On examination, his abdomen was diffusely tender. He was admitted to the hospital for further testing.
Question: What is the correct diagnosis and management plan for this patient?
MRCP2-2580
A 26-year-old man with chronic renal failure received a renal transplant from a matched related donor. After being discharged with a functioning graft, he returned to the nephrology clinic a month later with a high fever and was admitted for further investigation. During his first evening in the hospital, his condition rapidly worsened, and he became dyspneic. A full blood count revealed significant leukopenia, and his liver function tests were severely abnormal. What is the probable cause of his illness?