Archives: MRCP Part 2

MRCP2-1021

A 76-year-old man with learning difficulties presents with an acute exacerbation of congestive cardiac failure. He is currently taking bumetanide 2 mg TDS, carvedilol 25 mg OD, perindopril 4 mg BD, and spironolactone 100 mg OD. During examination, severe raised plaques of psoriasis are observed on his chest, elbows, knees, and scalp. The patient reveals that he has been using topical creams for years but has not seen any improvement and did not seek medical advice due to embarrassment. What is the recommended treatment for his psoriasis?

MRCP2-1022

A 68-year-old man presents with a four week history of skin rash. He reports that the rash appeared suddenly and has been progressing over the past four weeks.

The patient has a medical history of type 2 diabetes mellitus and is obese with a BMI of 38 kg/m². He also consumes alcohol excessively. A cirrhosis diagnosis was confirmed by an ultrasound scan conducted four years ago.

Upon examination, the patient has over 60 raised, oval-shaped lesions with tan pigmentation on his chest and back. The lesions range from 5 mm to 25mm in diameter and have a warty texture with a stuck-on appearance.

What would be the most appropriate next step for this patient?

MRCP2-1023

A 36-year-old male patient comes to you with a sudden appearance of a rash. He reports feeling generally healthy and has no significant medical history. Upon reviewing his records, you note that he recently received amoxicillin for tonsillitis. During the physical examination, you observe multiple papules on his trunk and proximal extremities, some of which have a fine scale. What is the probable diagnosis?

MRCP2-1024

A 55-year-old woman presents to your clinic with an itchy rash on her forearms. The rash consists of multiple small violaceous polygonal papules, primarily clustered around the wrist flexors. She has a history of left ventricular failure and was recently started on 5mg bisoprolol once daily. Her blood work is normal.

What is a true statement about this condition?

MRCP2-1025

A 23-year-old female with a history of iron deficient anaemia and eczema visits the clinic with a skin rash. She is currently taking ferrous sulphate 200mg twice daily and no other medications. Upon examination, she presents with an itchy bullous rash consisting of papules and blisters on her elbows and knees. A skin biopsy reveals immunoglobulin A (IgA) deposition in a granular pattern within the upper dermis. What would be the most suitable treatment for her condition?

MRCP2-1026

A 20-year-old man with a history of learning difficulties and eczema presents to the dermatology clinic with his parents. Despite using E45 cream three times a day, his eczema is difficult to control and has had several episodes of infection in the past. Currently, there is no sign of infection, but his flexural folds are erythematous with clear discharge. His parents are seeking advice on additional measures to manage his eczema.

MRCP2-1027

A 45-year-old male patient complains of a painful rash with erosions in his mouth and genitals for the past three days. He has been prescribed allopurinol for gout recently. The patient is febrile and looks unwell. During the examination, targetoid papules and plaques are observed on his face, trunk, and limbs.

What is the crucial initial step in managing this patient?

MRCP2-1028

A 45-year-old male patient complains of a painful rash that has been present for three days. The rash is widespread and accompanied by erosions in his mouth and genital area. The patient has recently been prescribed allopurinol for gout. He has a fever and appears unwell.

During the examination, the patient displays dusky, targetoid papules and plaques on his face, trunk, and limbs. The skin easily desquamates upon rubbing.

What is the most likely diagnosis?

MRCP2-1029

A 35-year-old woman came to the clinic complaining of severe itching for the past 2 weeks, mainly in the folds of her arms and legs. Upon examination, there were signs of inflammation and papules.
What is the initial treatment option for this condition?

MRCP2-1030

A 35-year-old woman presents to the Genitourinary Clinic with a 4-day history of vulval itching. She denies any fever or lower urinary tract symptoms and reports no vaginal discharge. She had unprotected sex with a new partner three weeks ago. She has no significant medical history and is not taking any medication other than regular folic acid. She has no known allergies. She is currently 14 weeks pregnant.

During the examination, her temperature is 36.5 °C, heart rate is 80 bpm, and blood pressure is 120/70 mmHg. Her abdomen is soft and non-tender. Multiple flesh-colored papules are visible around the vulva, with the largest measuring 4 mm in diameter. Some of the papules have an irregular border with mild bleeding.

What is the most appropriate next step in managing this patient?