A 45-year-old woman presents with increasing breathlessness and angina pain. Examination reveals pale conjunctivae. She has evidence of a left lower lobe consolidation on auscultation of the chest. Petechiae are present on the lower limbs. Observations: Blood pressure 125/79 mmHg Heart rate 100 bpm, regular Temperature 37.9 °C Oxygen saturations 94% on air Investigations: Investigation Result Normal values Haemoglobin (Hb) 75 g/l 135 – 175 g/l White cell count (WCC) 2.5 × 109/l 4.0 – 11.0 × 109/l Platelets (PLT) 23 × 109/l 150 – 400 × 109/l Blood film Blast cells with Auer rods Given the likely clinical diagnosis, what feature is most associated with a negative prognosis?
MRCP2-2378
A 30-year-old woman has been diagnosed with iron deficiency anemia after extensive investigation. Despite no source of blood loss or malabsorption being found, she has been taking ferrous sulfate twice daily for three months with no improvement in her iron indices or hemoglobin levels. Additionally, she reports experiencing bloating, loose bowel movements, and nausea when taking the iron tablets, which has significantly impacted her quality of life. What should be the next step in her treatment plan?
MRCP2-2379
A 50-year-old teacher presents to the haemato-oncology unit with a diagnosis of chronic lymphocytic leukaemia (CLL) following recurrent herpes simplex infection, two episodes of pneumonia and lymphadenopathy. The patient has an overwhelming lymphocytosis with a white count of 62 × 109/l. The consultant notes indicate that the patient is to be started on fludarabine. What pre-treatment medication must be administered to the patient?
MRCP2-2380
Which statement aligns with the red blood cell membrane condition known as hereditary elliptocytosis?
MRCP2-2381
A 65-year-old man presented to the hospital complaining of severe back and groin pain. He had no history of trauma, cancer, or previous back issues, but was being treated for hypertension, type 2 diabetes, and atrial fibrillation with rivaroxaban. Upon examination, his blood pressure was 108/67 mmHg and his heart rate was 102/min. His urine dip showed 1+ protein and 1+ blood. There were no abnormalities found during chest and neurological examination, but he experienced pain when flexing his hip. His condition initially improved after receiving fluids. What is the most likely diagnosis?
MRCP2-2382
A 72-year-old retired teacher with rapidly worsening lower back pain presents to your clinic. The pain began 8 months ago after a slip and fall. Lumbar spine X-ray confirmed vertebral collapse of L3 and L5. She was started on calcium/vitamin D3 and a bisphosphonate. The pain has now spread to her cervical spine. The pain does not vary with time of day or activity level. She has noticed a decrease in appetite but her weight has remained stable. She used to smoke in her younger years. She has a history of hypertension.
Her current medications include regular opioid pain medication, a diuretic, and a cholesterol-lowering medication. On examination, she appears pale. Cardiovascular, chest, and abdominal exams are unremarkable. She is tender over her cervical, thoracic, and lumbar spine. Neurological exam is limited due to pain. Chest X-ray shows a slightly enlarged cardiac shadow. Cervical spine X-ray shows collapse of C3. Thoracic spine X-ray shows collapse of T2 and T6. Lumbar spine X-ray shows collapse of L3 and L5.
Lab results show a normocytic anemia with rouleaux formation, low white blood cell count, and low platelet count. Her sodium, bilirubin, and ALT levels are within normal limits. However, her creatinine, urea, and calcium levels are elevated. Her albumin and total protein levels are low. Her phosphate level is slightly elevated. Her ESR is elevated and her CRP is within normal limits. Urinalysis reveals 2+ protein.
What is the most likely diagnosis?
MRCP2-2383
A 20-year-old woman has been diagnosed with acute lymphoblastic leukemia and requires weekly lumbar punctures for intrathecal chemotherapy. During her third course of treatment, her platelet count is found to be 25 ×109/L (150-400 ×109/L). What is the recommended course of action in this situation?
MRCP2-2384
A 25-year-old man presents with jaundice two weeks after a mild flu-like illness. His partner noticed the yellowing of his skin. Upon investigation, his hemoglobin, MCV, WCC, and platelet count are within normal range, but his reticulocyte count is elevated. His albumin level is slightly low, while his total bilirubin level is significantly high. His AST and ALP levels are within normal range, and his urine dipstick shows a positive result for urobilinogen and blood, but negative for bilirubin and protein. What diagnostic test would be most effective in confirming the diagnosis?
MRCP2-2385
A 30 year old man is admitted to the acute medical unit with a left lobar pneumonia. Upon reviewing his medical history, it is discovered that he has been admitted three times in the past five years with similar presentations. He has no significant medical history except for a few episodes of sinusitis. Following treatment for his pneumonia, his blood differential is normal and his HIV test is negative. What could be the underlying diagnosis?
MRCP2-2386
A 16-year-old boy with sickle cell disease complains of pain in his right thigh. Upon examination, a plain x-ray reveals signs of osteomyelitis in the right femur. What is the probable causative agent responsible for this condition?