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?

MRCP2-0990

A 68-year-old man presents to the medical clinic with ongoing itching despite treatment for scabies prescribed by his GP two weeks ago. His daughter assisted with the treatment, which included two sessions of permethrin 5% and washing of clothes and bed sheets at high temperature. The patient has a history of heart failure, ischaemic heart disease, and dementia and lives with his daughters. On examination, burrows with track marks are visible on his fingers. What is the best course of action?

MRCP2-0991

A 28-year-old woman presents with a facial rash that has been present for a few weeks. The rash appears erythematous, greasy, and has a fine scale on her cheeks, nasolabial folds, eyebrows, nasal bridge, and scalp. What is the probable diagnosis?

MRCP2-0992

A 68-year-old man comes to the dermatology clinic for evaluation of a suspicious skin lesion. He has noticed that a particular mole has been irritated and rubbing against his shirt. On his back, there is an 11x13mm brown lesion with an irregular border and variation in color. Upon examination with a dermatoscope, there is no telangiectasia, and the lesion appears to have dark pigmented pinprick spots within the brown lesion. What aspect of this description provides reassurance that the diagnosis is more likely to be benign?

MRCP2-0993

An 80-year-old man comes to the Dermatology Clinic with a progressively worsening erythematous rash that has developed over the past six months. The rash appears as concentric erythematous bands, similar to the rings found on a tree trunk. He has a persistent cough, likely due to his history of smoking, which he quit 25 years ago, and underwent surgery for an inguinal hernia five years ago. What is the most probable malignancy underlying his symptoms?

MRCP2-0994

What is the most accurate way to describe a raised lesion measuring 6 cm in diameter that appears erythematous and scaly upon skin examination of a patient with a rash?

MRCP2-0995

How would you describe the multiple, small, raised, slightly dome-shaped lesions containing purulent material observed during a skin examination of a patient?