Archives: MRCP Part 2

MRCP2-2537

A 28-year-old man presented with fever, headache, a dry cough, and bloody diarrhoea. Symptoms started nine days ago. Seven weeks earlier he had been on an adventure holiday in Zambia with a group of friends, which involved rafting and visiting a game reserve. A couple of his friends had developed a similar illness. On examination, he was febrile, and was noted to have an urticarial rash on his trunk. He had a polyphonic wheeze in both lung fields and the tip of his spleen was palpable.

What is the pathogen causing the patient’s symptoms?

MRCP2-2538

A 35-year-old man with HIV disease visits the clinic after eight weeks of starting highly active antiretroviral therapy (HAART). He had been in good health before starting the treatment, but now he complains of feeling tired and weak. His HAART regimen includes two nucleoside analogues (zidovudine [AZT] and lamivudine [3TC]) and a protease inhibitor (nelfinavir). Additionally, he takes co-trimoxazole to prevent Pneumocystis jirovecii pneumonia.

The patient’s haemoglobin levels were 125 g/L before starting the treatment and have dropped to 81 g/L after eight weeks. The normal range for haemoglobin is 130-180 g/L. His MCV levels were 96 fL before treatment and have increased to 101 fL after eight weeks.

What is the most likely reason for his anaemia?

MRCP2-2539

A 40-year-old man presents with a fever and productive cough of green sputum. He had a headache and general malaise four days prior to presentation, and now has a high fever and pain in his left side. He is married with two children, works as an accounts clerk, and is typically healthy. He does not smoke and drinks approximately 10 units of alcohol per week. On examination, he is febrile with coarse crepitations heard at the base of the left lung. Investigations reveal elevated white cell count and neutrophils, as well as left lower lobar consolidation on chest x-ray. Which of the following features is an adverse prognostic marker in this patient?

MRCP2-2540

A 32-year-old male presents to the medical take with concerns of frank haematuria for the past week. He has been unable to schedule an appointment with his GP. He reports no dysuria or frequency and has experienced similar episodes of haematuria in the past that resolved spontaneously after a day or two. He has a history of hypertension and is currently taking medication for it. He works as a software engineer and lives with his wife and two children. On examination, his abdomen is soft and non-tender. His Rinne and Weber tests are normal.

Investigations reveal:
– Haemoglobin: 135g/l
– WCC: 7 x 10^9/l
– Platelets: 320 x 10^9/l
– Sodium: 140 mmol/l
– Potassium: 4.8 mmol/l
– Urea: 8 mmol/l
– Creatinine: 180 mmol/l
– Urine dip blood +++, protein +, leucocytes negative, nitrites negative

What is the most likely diagnosis?

MRCP2-2541

A 32-year-old woman is brought to the Emergency Department from her workplace, having just collapsed after experiencing severe vomiting and diarrhea. Her coworker reports that she had been complaining of high-volume, painless, watery diarrhea for the past two days. On examination, her blood pressure is 90/60 mmHg and her pulse is 110/min and regular. Gram-negative bacilli are seen on dark-field microscopy of a fresh stool specimen. Based on the most likely diagnosis, which of the following antibiotic options would be the most appropriate for treating this patient?

MRCP2-2542

A 35-year-old woman presents to the Emergency Department with a 2-week history of intermittent fever and flu-like symptoms. She complains of general malaise and myalgia. There is no significant medical history and she has otherwise been healthy, having recently returned from a hiking vacation. She has no known allergies.

Upon examination, she appears fatigued. She has a heart rate of 98 bpm and blood pressure of 120/80 mmHg. The rest of her vital signs are normal. On her right arm, there is a circular lesion with a red center and a pale ring around it. There is no evidence of crusting or bleeding and the rest of her skin and mucosa are unaffected.

She is prescribed an antimicrobial medication. What is the mechanism of action of this medication?

MRCP2-2543

A 40-year-old man has been diagnosed with acute lymphoblastic leukemia and has undergone a matched sibling allogeneic hematopoietic stem cell transplant. After one month, he experiences persistent profuse hemoptysis despite platelet support and low-grade fever. What would be the next step in his treatment?

MRCP2-2544

A 35-year-old patient undergoing chemotherapy for Hodgkin’s lymphoma presents with a persistent fever. Blood tests reveal neutropenia and the patient is started on piperacillin/tazobactam and gentamicin for febrile neutropenia. Despite this, the fever continues and on day 3, the antibiotics are changed to meropenem and vancomycin. Further investigations reveal invasive aspergillosis on a high-resolution CT scan of the chest. What would be an appropriate treatment option in this case?

MRCP2-2545

A 50 year old man attends the Genitourinary clinic and is diagnosed with HIV. During his routine HIV work up, it is found that he has a positive HLA B*5701 result. Which medication will be excluded from his ART regimen due to this information?

MRCP2-2546

A 50 year-old patient complains of feeling unwell for the past week, experiencing nausea and breathlessness. This individual is HIV positive and has recently begun anti-retroviral therapy while residing in South Africa. Upon examination, the chest appears clear. The following test results were obtained:

– Chest X-ray: No abnormalities detected
– CD4 count: 380 cells/mm³
– Amylase: 800 units/dL
– Lactate: 3.8 mmol/L

What is the probable underlying cause of these symptoms?