Archives: MRCP Part 2

MRCP2-0997

A 35-year-old woman of Indian origin is started on carbamazepine for generalized tonic-clonic seizures. She presents to the Emergency Department (ED) a few days later complaining of symptoms of lower respiratory tract infection (RTI), and severe blistering affecting her mouth and lips.
During examination, her temperature is 38.5°C. Her blood pressure (BP) is 120/80 mmHg, while her pulse is 85 beats per minute (bpm) and regular. You confirm a number of blisters within the oropharynx. She has a number of target lesions over the surface of her body, some of which have blistered with a necrotic center. In certain areas, the lesions have become confluent, with wider areas of skin loss.
Investigations reveal the following:
Haemoglobin (Hb) 140 g/l 120–160 g/l
White cell count (WCC) 12.5 × 109/l 4.0–11.0 × 109/l
Platelets (PLT) 180 × 109/l 150–400 × 109/l
Sodium (Na+) 138 mmol/l 135–145 mmol/l
Potassium (K+) 3.8 mmol/l 3.5–5.0 mmol/l
Creatinine (Cr) 100 µmol/l 50–120 µmol/l
Glucose 6.0 mmol/l 3.9–7.1 mmol/l
Erythrocyte sedimentation rate (ESR) 70 mm/hour 1–20 mm/hour

What is the most probable diagnosis?

MRCP2-0998

A 27-year-old woman presents to the dermatology clinic for follow-up of her eczema. She has a long history of eczema and has noticed that the current weather conditions have been exacerbating her symptoms. Despite applying emollients four times a day, she has not seen any improvement in her dry skin. She has a history of well-controlled asthma and only rarely uses her inhaler. She is not currently using any creams other than lotion emollients and has previously required topical steroids for severe eczema flare-ups. On examination, her flexural folds appear very dry but not inflamed. What recommendations can be made to manage her dry skin?

MRCP2-0999

A 55-year-old man comes in with a lesion on his tongue. He has been experiencing a strange sensation in his tongue and has noticed a white rash on the side of his tongue that cannot be wiped away. He has a medical history of recurrent herpes simplex sores, HIV, hypertension, and a surgery for an ankle fracture. He is currently taking only losartan. Upon examination, there is a deeply grooved white lesion on the side of his tongue. What is the best course of treatment to resolve the lesion?

MRCP2-1000

A 38-year-old pet shop owner presents to the dermatology clinic with lesions on his right hand. He reports noticing a lump over his 2nd metacarpophalangeal joint 2 months ago, which has since increased in size and crusted over, and additional similar lesions have appeared. He denies experiencing pain or itching and has attempted to treat the lesions with various topical emollients without success. The patient has no significant medical history or allergies.

Upon examination, multiple crusted lesions measuring 1-2 cm in diameter are observed on the patient’s knuckles and the dorsum of his hand. No other skin or mucosal changes are noted.

A skin biopsy is performed and reveals granulomatous dermatitis with inflammatory infiltrate. What is the most probable causative organism?

MRCP2-0982

A 40-year-old woman with a history of psoriasis visits your clinic with complaints of a severe flare-up. She appears distressed and reveals that her condition is significantly impacting her daily life. The patient is currently taking methotrexate and folic acid for long-term maintenance, following an unsuccessful attempt at phototherapy and an apparent allergic reaction to cyclosporin. What would be your next course of action in managing her condition?

MRCP2-0983

A 35-year-old woman presents with a painful ulcer on her right lower limb. She reports developing a painful erythematous area that quickly progressed to an ulcer with purple discolored edges. She recently knocked the area while riding her bike to work. She has also been experiencing mild abdominal pain and opening her bowels around eight times a day with some mucous, which she attributes to irritable bowel syndrome. Her medical history includes migraines and a previous deep vein thrombosis. A biopsy of the ulcer showed heavy neutrophil infiltration. What is the most likely diagnosis?

MRCP2-0984

A 40-year-old landscaper was sent to the dermatology clinic due to a raised, well-defined red lesion on his finger. The lesion had been growing steadily for the past three weeks, causing tenderness and bleeding upon contact. What is the probable diagnosis?

MRCP2-0985

A 35-year-old man visits his family doctor (FD) after becoming worried about a new mole on his left arm. The mole has only been there for a few months, but the patient has noticed that it has become darker in colour and has an irregular shape.
Upon examination, he has a slightly raised dark lesion on the posterior aspect of his left arm. The lesion measures 6 mm and has an irregular border.
The FD immediately refers the patient to the local Dermatology Unit for an excisional biopsy for a suspected diagnosis of melanoma.
Which of the following is NOT a primary risk factor for the development of melanoma?

MRCP2-0986

A 65-year-old man comes to the clinic with a facial rash that becomes more prominent during the summer season. He reports experiencing flushing after being exposed to sunlight in his garden and consuming spicy foods.

During the examination, the patient displays an erythematous, papular rash on his forehead and cheeks. Pustules are visible around his cheeks and forehead. The rash is confined to his face, and there are no comedones.

What would be the most suitable initial treatment option?

MRCP2-0987

A 30-year-old mother, who is currently nursing her baby, has been prescribed prednisolone for a severe eczema flare-up.
What advice should be given regarding her breastfeeding?