A 50-year-old woman visits her doctor complaining of a painful rash on her breasts. The rash appeared within the last day and has become more defined and darker in color. She recently started taking warfarin for a deep vein thrombosis and has a medical history of hypothyroidism, type two diabetes, and obesity. She has been on warfarin before but does not recall experiencing this rash. Her blood tests show a prothrombin time of 21.4 seconds and an INR of 2.1. What is the most likely diagnosis?
MRCP2-2388
A 35-year-old man with chronic immune thrombocytopenia is scheduled to undergo an elective splenectomy after failing to respond to medical therapy. As per guidelines, which vaccinations does he require?
MRCP2-2389
A 62-year-old male comes to the clinic with a platelet count of 768 ×109/L (150 – 400). He has mild splenomegaly upon examination, but no other significant findings in his history or physical exam. What diagnostic test would be most helpful in determining the cause of his elevated platelet count?
MRCP2-2390
A 42-year-old woman presents to her primary care physician (PCP) with complaints of unexplained weight loss over the past six months and excessive sweating at night. She also reports experiencing persistent itching all over her body. She has no significant medical history and is a non-smoker. She has not traveled recently. Upon examination, the patient is afebrile, but there is symmetrical lymphadenopathy in the cervical and supraclavicular regions. No hepatomegaly or splenomegaly is noted. The following laboratory results are obtained: Erythrocyte sedimentation rate (ESR) 175 mm/hour 1–20 mm/hour Hemoglobin (Hb) 140 g/l 135–175 g/l White blood cell count (WBC) 5.2 × 109/l 4.0–11.0 × 109/l Platelet count (PLT) 300 × 109/l 150–400 × 109/l Sodium (Na+) 142 mmol/l 135–145 mmol/l Potassium (K+) 4.0 mmol/l 3.5–5.0 mmol/l Urea 5.0 mmol/l 2.5–6.5 mmol/l Creatinine (Cr) 80 µmol/l 50–120 µmol/l A CT scan of the chest, abdomen, and pelvis reveals involvement of lymph nodes in the neck, chest, and abdomen. A lymph node biopsy confirms the diagnosis of Hodgkin’s lymphoma. What would be the clinical stage of this patient’s disease according to the Ann Arbor classification?
MRCP2-2391
A 65-year-old woman presents to her new primary care physician with complaints of fatigue and weakness. She has a history of high blood pressure managed with lisinopril and amlodipine and has been experiencing back pain for the past 6 months. On examination, her blood pressure is 130/70 mmHg, pulse is 80 bpm and regular, and there is mild bilateral ankle edema. Lab results show: – Hemoglobin (Hb): 105 g/L (normal range: 120-160 g/L) – White blood cell count (WBC): 12.2 x 10^9/L (normal range: 4.0-11.0 x 10^9/L) – Platelets (PLT): 180 x 10^9/L (normal range: 150-400 x 10^9/L) – Sodium (Na+): 140 mmol/L (normal range: 135-145 mmol/L) – Potassium (K+): 4.2 mmol/L (normal range: 3.5-5.0 mmol/L) – Creatinine (Cr): 100 µmol/L (normal range: 50-120 µmol/L) – Albumin: 30 g/L (normal range: 35-55 g/L) – Total protein: 62 g/L (normal range: 60-83 g/L)
Which of the following findings would be most suggestive of symptomatic myeloma?
MRCP2-2370
A 16-year-old male from India presents with a 10-hour history of priapism. He has a medical history of intermittent back and abdominal pain. During examination, he appears pale and has a fever of 39°C. He also has an enlarged smooth liver and a painful engorged penis. Laboratory tests reveal a haemoglobin level of 85 g/L (130-180), MCV of 81 fL (80-96), white cell count of 12.2 ×109/L (4-11), and platelets of 450 ×109/L (150-400). What is the most likely diagnosis?
MRCP2-2371
A 23-year-old man with sickle cell disease presents to the Emergency Department with worsening pain in his arms and legs over the past 48 hours. He also reports a painful sustained erection that started 6 hours ago. He has no significant past medical history and is currently taking paracetamol, ibuprofen, folate, and penicillin. He has never received regular transfusions and has only been admitted once before for a crisis.
On examination, his heart rate is 108 beats per minute and his blood pressure is 130/90 mmHg. His oxygen saturation is 97% on room air and he is afebrile. There is no swelling or erythema of his limbs, but they are tender to touch. He continues to have a painful erection, but there is no sign of ischaemia.
His chest x-ray is clear and his blood tests show a hemoglobin level of 80 g/l, platelets of 320 * 109/l, and a CRP of 12 mg/l.
He is given intravenous fluids and diamorphine for pain relief, which improves his limb pain but not his painful erection.
What is the most appropriate next step in management?
MRCP2-2372
A 45-year-old male patient has been referred to the endocrinology clinic due to newly diagnosed, poorly controlled diabetes mellitus. He is also experiencing lethargy and has recently developed erectile dysfunction. During the examination, the patient reports bilateral knee discomfort, but no other pathology is detected except for a 3 cm hepatomegaly. Blood tests reveal abnormal liver function. What should be the next step in managing this patient’s condition?
MRCP2-2373
A 25-year-old man presents with diffuse bruising, abdominal pain, and loss of appetite. He feels unwell and has no history of taking any medications, does not use dietary supplements, and does not use illicit drugs. His past medical history is negative for any prior illnesses or hospitalisations. No family history of any bleeding disorders.
On examination, he has a heart rate of 115 bpm with a blood pressure of 130/75 mmHg. His respiratory rate is 18 breaths per minute and he is afebrile with a temperature of 37.2ºC. His abdominal exam demonstrates rebound tenderness in the right lower quadrant.
A diagnosis of acute appendicitis is made and the general surgical team decides that the patient needs to be taken to theatre for an urgent laparoscopic appendectomy.
What is the next best step in managing this patient?
MRCP2-2374
A 85-year-old man is being seen by his oncologist for monitoring of his recently diagnosed chronic lymphocytic leukaemia (CLL). He is scheduled to undergo genetic testing to determine his prognosis. What factors are associated with a poor prognosis in his condition?