Archives: MRCP Part 2

MRCP2-2581

A woman who is 30 weeks pregnant presents feeling unwell with frequency and pain on urination.

On examination, she is pyrexial 37.9 °C and has suprapubic tenderness.

Investigations reveal the following:

Investigation Result Normal value

Haemoglobin (Hb) 111 g/l 115–155 g/l

White cell count (WCC) 13.1 × 109/l 4.0–11.0 × 109/l

Platelets (PLT) 145 × 109/l 150–400 × 109/l

Sodium (Na+) 139 mmol/l 135–145 mmol/l

Potassium (K+) 4.9 mmol/l 3.5–5.0 mmol/l

Creatinine (Cr) 90 µmol/l 50–120 µmol/l

Urine Nitrites, blood and protein ++

Which of the following is the most likely infective organism?

MRCP2-2582

A 76-year-old driver with a history of chronic obstructive pulmonary disease was hospitalized after a car accident resulting in severe head injury. He was admitted to the intensive care unit and required tracheal intubation and ventilation. After five days, he experienced haemoptysis and was found to have coarse crackles in the right lower lung. The microbiology laboratory received a tracheal aspirate sample, which revealed the following results: white blood cell count of 9,000, 75% neutrophils, 24% lymphocytes, and Gram-negative bacilli. What is the most likely causative organism?

MRCP2-2583

A 25-year-old male patient complains of dysuria and a discharge from the urethra. Upon examination, neutrophils are found in the urethral discharge, but no bacteria are present. What is the most probable organism responsible for this condition?

MRCP2-2552

A 25-year-old Somali woman attends her booking appointment in the UK for her first pregnancy. During screening tests, it is discovered that she is HIV positive, although she is asymptomatic. Her viral load is 150,000 copies/ml and her CD4 count is 523 cells/mm³. No viral resistance is detected, and her hepatitis serology is negative. Her husband tests negative for HIV. She is started on triple antiretroviral therapy (ART) with zidovudine, lamivudine, and lopinavir/ritonavir, and by 36 weeks, her viral load is undetectable at <20 copies/ml. What is true regarding her ongoing management?

MRCP2-2553

A 50-year-old woman presents to her local out of hours GP with concerns about having contracted Lyme disease after a recent day out in the New Forest in Hampshire, UK. She is urgently referred for assessment by the infectious diseases team due to her anxiety and a close friend’s experience with neuroborreliosis. The patient reports finding two engorged ticks on her right lower leg after the walk and her husband removed them with nail polish and tweezers. She denies any symptoms and has no known drug allergies. On examination, no abnormal skin changes or neurological signs are identified. What is the appropriate management for this patient’s tick bites?

MRCP2-2554

A 35-year-old woman visits the Sexual Health Clinic for evaluation. She is five months’ pregnant and has had dysuria and vague lower abdominal pain for the past few days. She recently ended a long-term relationship after discovering her partner had been unfaithful.
During the examination, her temperature is 37.2 °C, blood pressure is 120/80 mmHg, and abdomen appear normal. Chlamydia testing is positive, but urine culture is negative for common urinary tract infection pathogens.
What is the best course of action in this situation?

MRCP2-2555

A 23-year-old woman is referred to the Infectious Diseases Clinic for evaluation. Her symptoms started about eight weeks ago, when she experienced cold-like symptoms for approximately two weeks. Although those symptoms resolved, she now suffers from bouts of rapid coughing that sometimes lead to vomiting. She reports feeling exhausted after these episodes. Upon auscultation of her chest, her breath sounds are normal. She did not receive childhood vaccinations.
The following are the results of her investigations:
Investigations Results Normal Values
Haemoglobin (Hb) 138 g/l 135 – 175 g/l
White cell count (WCC) 8.5 × 109/l 4.0 – 11.0 × 109/l
Platelets (PLT) 290 × 109/l 150 – 400 × 109/l
Sodium (Na+) 142 mmol/l 135 – 145 mmol/l
Potassium (K+) 4.6 mmol/l 3.5 – 5.0 mmol/l
Creatinine (Cr) 118 µmol/l 50 – 120 µmol/l
C-reactive protein (CRP) 32 mg/l < 10 mg/l
What is the most probable cause of her symptoms?

MRCP2-2556

A 20-year-old female patient presented at the hospital with symptoms of nausea, vomiting, headache, and lethargy. Upon examination, the patient appeared confused and had erythematous macules on her lower extremities and trunk, but not on her face. The patient also had a stiff neck with a positive Kernig’s sign. During lumbar puncture, the CSF had high pressure and was turbid with increased protein levels and neutrophilic leukocytosis. The Gram stain of the CSF revealed Gram-negative cocci. What is the etiological agent responsible for this disease?

MRCP2-2557

A 28-year-old female patient presents to the GUM Clinic with concerns about an unpleasant-smelling vaginal discharge. She has been experiencing these symptoms for the past 2 weeks and has been washing her genital area regularly with soap and shower gel. She has also been using Dettol in her bath. She is in a committed relationship and has not had any other sexual partners for the past 3 years. On examination, her vulva, vagina, and cervix appear normal, but there is a thin, white discharge with a fishy odor. What is the most likely diagnosis?

MRCP2-2558

A 32-year-old female patient visited the genitourinary medicine clinic with a complaint of vaginal discharge. She had previously consulted her GP who prescribed clotrimazole pessaries, but she did not experience any relief. The patient reported no itching but mentioned a foul odor, particularly after intercourse. During the examination, a thin white vaginal discharge with a pH of 5.9 was observed, and microscopy revealed Lactobacilli with Gram variable rods. What is the most suitable treatment option?