Archives: MRCP Part 2

MRCP2-1066

A 25-year-old female presents with acute illness. She has been experiencing weight loss, tiredness, and lethargy for the past three months, which has worsened over the last week. Her general practitioner had diagnosed her with hypothyroidism six weeks ago, with a Free T4 level of 8.8 pmol/L (10-22) and a Plasma TSH level of 5.5 mU/L (0.4-5). She had started taking thyroxine 50 µg daily but has deteriorated over the last two weeks. Her mother and maternal grandmother have also been diagnosed with hypothyroidism and take thyroxine. She is a non-smoker, does not drink alcohol, and takes the oral contraceptive pill.

On examination, she appears unwell and mildly dehydrated, with a temperature of 37.5°C and a BMI of 21.3 kg/m2. Her blood pressure is 72/44 mmHg, with a pulse of 100 beats per minute. Cardiovascular examination is otherwise normal, and there are no abnormalities on respiratory or abdominal examination. Brief neurological examination is normal, and both plantars are flexor.

The investigations requested by the house officer are currently unavailable. In the meantime, what is the most appropriate immediate management for this patient?

MRCP2-1067

A 35-year-old man presents to the Emergency Department two weeks after being discharged following surgery for a ruptured appendix. He experienced significant blood loss during the procedure and required a blood transfusion. He has been feeling increasingly fatigued with episodes of dizziness and near-fainting. On examination, he appears pale and his blood pressure is 100/70 mmHg with a 15 mmHg drop on standing. His pulse is 90 bpm and regular. His BMI is 25 kg/m2.

Investigations:
Haemoglobin (Hb): 105 g/l (normal range: 130-170 g/l)
White cell count (WCC): 7.5 × 109/l (normal range: 4-11 × 109/l)
Platelets (PLT): 180 × 109/l (normal range: 150-400 × 109/l)
Sodium (Na+): 132 mmol/l (normal range: 135-145 mmol/l)
Potassium (K+): 5.2 mmol/l (normal range: 3.5-5.0 mmol/l)
Creatinine (Cr): 100 µmol/l (normal range: 50-120 µmol/l)

What is the underlying pathology causing this patient’s symptoms?

MRCP2-1031

A 42-year-old man visits the Dermatology Clinic with a poorly defined, pearly nodule measuring 0.8 cm in diameter. The lesion is located in the medial canthus, 7 mm from his right lower eyelid, and is accompanied by arborising telangiectasia. What is the most effective treatment option to prevent recurrence and achieve optimal cosmetic results?

MRCP2-1032

A 28-year-old woman presents to the Dermatologist with complaints of a rash over her face, neck and upper back for the past two weeks. She also complains of intense itching, further adding that she is unable to sleep at night because of the itching. There is a history of intravenous (IV) drug use.

On examination, her blood pressure is 110/70 mmHg and her heart rate is 80 bpm. She appears thin and there are multiple needle marks present near the cubital fossa. There are multiple papulopustular lesions present over the face, neck and upper back. Oral examination reveals the presence of a whitish membrane suggestive of oral thrush.

What treatment option will lead to resolution of this patient’s skin lesions?

MRCP2-1033

An 80-year-old woman comes to the Emergency Department (ED) complaining of occasional pain in her upper left chest. She has had a blistering rash in the area for the past four days, which has been oozing and causing a burning sensation. She had chickenpox as a child.
During the examination, a clearly defined rash is observed, consisting of scabbed and healing blisters that correspond to a single dermatome.
What is the best course of treatment for this patient?

MRCP2-1034

A 45-year-old man with HIV has a CD4 count of 220 × 106/l. He is feeling generally well but has noticed some white patches in his mouth that are bothering him. Upon examination, you observe irregular white patches with a rough texture on the side of his tongue. They cannot be removed with a swab. What is the most effective treatment for these patches?

MRCP2-1035

A 32-year-old woman with extensive, chronic plaque psoriasis and joint inflammation in both knees has not achieved satisfactory results with escalating doses of oral methotrexate.
She has previously been unsuccessful with therapies such as light therapy, cyclosporine, and various topical medications.
What is the most suitable course of treatment?

MRCP2-1036

A 25-year-old man comes to the doctor with recurring skin lesions over the past six months. He is not taking any medications and uses condoms for contraception. Upon examination, the doctor observes thick, greasy, yellowish-white scales on the scalp, eyebrows, side of the nose, and ears. There are no other lesions on the body. What is the recommended treatment for this condition?

MRCP2-1037

A 30-year-old woman is receiving IV co-trimoxazole in the hospital. She initially showed signs of improvement, but now she has developed a fever, joint pain, oral and genital ulcers, and target-like lesions on her palms and soles that have spread to her face and trunk. The lesions have become tender and blistered, and lateral pressure causes erosions. The vancomycin has been discontinued.
What is the most appropriate next step in managing this patient?

MRCP2-1038

A 70-year-old man, with a history of ischaemic heart disease (IHD), chronic kidney disease (CKD), treated hypothyroidism, systemic lupus erythematosus (SLE) and a 60 pack/year smoking history, presents with extremely painful, necrotic ulcers on his abdomen, thighs and shins. He reports that these ulcers typically start as areas of blue/black discoloured skin before they deteriorate. What is the most significant risk factor for the development of his calciphylaxis?