Archives: MRCP Part 2

MRCP2-2527

A 25 year-old traveler presents with a febrile illness, ten days after returning from a trip to India. She delayed seeking medical attention because she assumed it was a common illness, having experienced similar symptoms during previous travels. She did not take malaria prophylaxis due to concerns about side effects. The illness began three days after her return, with a recorded temperature of 38.6°C. She also complains of severe joint pains and headache, particularly behind her eyes. Today she has noticed some bruising and bleeding from her gums.

On examination, her temperature is 38.4°C and she has a widespread macular rash with areas of sparing. There are also petechial haemorrhages on her limbs. Cardio-respiratory examination is unremarkable except for a heart rate of 110. Blood pressure is 120/80 mmHg. On palpation of the abdomen, you discover tender hepatomegaly. Neurological examination is normal.

After applying a tourniquet to take a blood sample, you notice that the area under the tourniquet has become bruised.

Results of blood tests are as follows:

Hb 13.8 g/dl
MCV 92.4 fl
Haematocrit 0.54
Platelets 25 x10^9/l
WCC 5.9 x10^9/l

Na+ 136 mmol/l
K+ 4.2 mmol/l
Urea 4.1 mmol/l
Creatinine 75 µmol/l

ALT 58 IU/l
ALP 72 IU/l
Bilirubin 12 mol/l
Albumin 30 g/l

Rapid Malaria test Negative
Thick and thin blood films Pending

What is the most likely diagnosis?

MRCP2-2528

A 30-year-old man presents with symptoms of fever, muscle aches, headache, and rash after returning from a trip to Thailand. Upon admission, his chest X-ray appears normal and viral swabs come back negative. However, his urine dip shows 1+ protein and his platelet count is low. On the second day of his hospital stay, his blood pressure drops and his platelet and hemoglobin counts continue to decrease. What is the probable diagnosis?

MRCP2-2529

A 29-year-old female presents with a 5-day history of fevers and joint pain. She has recently returned from a 6 month gap year trip to South America four days ago and reports no ill health during her travels. She has no past medical history, does not smoke, drinks minimal alcohol and denies the use of illicit drugs. During her travels, she reports two episodes of unprotected sexual contact with a non-regular partner. Although she knew she would be entering a malaria area and was indeed bitten by mosquitoes on a number of occasions, she did not take any malaria prophylaxis.

On examination, heart sounds and chest examination are both normal. A maculopapular rash is noted on her left thigh and right upper arm, with bilateral conjunctival injection. Abdominal examination reveals a soft abdomen with no masses. She has significantly joint and muscle pains, limiting your neurological examination. She is alert and orientated to time and place, scoring 10/10 on abbreviated mental testing. Her blood tests are as follows:

Hb 110 g/l
Platelets 50 * 109/l
WBC 3.0 * 109/l

Na+ 138 mmol/l
K+ 3.9 mmol/l
Urea 6.8 mmol/l
Creatinine 95 µmol/l
CRP 75 mg/l

Bilirubin 8 µmol/l
ALP 32 u/l
ALT 160 u/l

Her first malaria film is negative and a chest radiograph is unremarkable.

What is the most likely diagnosis?

MRCP2-2530

A 30-year-old woman begins antiretroviral therapy for HIV and visits her GP after a week, reporting dizziness and nightmares. She is experiencing difficulty with work due to feeling confused and disconnected. Which medication is causing these symptoms?

MRCP2-2531

An older man comes in with a 4 day history of bloody diarrhea and fever. He has not traveled recently and has a medical history of hypertension, osteoarthritis, and gout. Upon examination, his temperature is 38.2ºC, heart rate 90/min, blood pressure 122/78 mmHg, and his abdomen is soft and non-tender. A stool sample has tested positive for Salmonella. What is the most effective treatment?

MRCP2-2532

A 20-year-old man returning from Zimbabwe presents to the emergency department with complaints of severe headache and rigors for the past three days. He has no significant medical history, smoked 10 cigarettes per day, and does not consume alcohol. On examination, he appears anxious and sweaty with a pulse rate of 108/min, blood pressure of 91/58 mmHg, temperature of 39ºC, and respiratory rate of 22/min. The chest is clear, heart sounds normal, and a brief neurological examination is unremarkable. An urgent blood film confirms malarial parasites. What clinical findings would indicate severe malaria infection?

MRCP2-2533

A 16-year-old girl arrived at the Emergency department with breathing difficulties. She had a history of asthma and had visited her general practitioner the day before with a sore throat. The doctor diagnosed her with tonsillitis and prescribed a 5-day course of oral amoxicillin. The patient also had ulcerative colitis and was taking inhaled salbutamol, beclomethasone, and mesalazine 400 mg tds regularly.

During the examination, the patient appeared distressed with laboured breathing and inspiratory wheeze. She was pale, sweaty, and cyanosed, with a temperature of 36.5°C, pulse of 120/minute, and blood pressure of 90/35 mmHg. The lungs were clear, but her breathing continued to worsen despite receiving high-flow oxygen through a face mask.

What is the most likely pathogen responsible for her condition?

MRCP2-2534

A 15-year-old girl arrives at the Emergency department with breathing difficulties. Earlier that day, she had visited her general practitioner for a sore throat and was diagnosed with tonsillitis. The doctor prescribed a five-day course of oral amoxicillin. The patient has a history of ulcerative colitis and takes mesalazine 400 mg tds regularly.

Upon examination, the girl appears distressed with laboured breathing and stridor. She is pale, sweaty, and cyanosed, sitting up with an open mouth and drooling saliva. Her temperature is 39°C, pulse 120/minute and regular, blood pressure 90/35 mmHg. Her lungs are clear.

What is the immediate treatment required for this patient?

MRCP2-2535

A 40-year-old traveler visited the Emergency department after returning from a trip to Thailand six weeks ago. During the examination, the patient had a fever (38.5°C), a diffuse macular rash, and generalised lymphadenopathy. Atypical lymphocytes were observed on a blood film. The patient had taken mefloquine as a malaria prophylaxis. What is the probable diagnosis?

MRCP2-2506

A 17-year-old boy presents with recurrent epistaxis and prolonged bleeding after accidental injuries. His initial blood tests reveal low Hb levels, impaired platelet aggregation, and low Factor VIIIc. What is the most probable diagnosis?