A 50-year-old male from Afghanistan comes to the clinic with a rash covering his entire body. He explains that the rash started as several small, light-colored spots that were not raised or rough. Over time, they have developed into plaques, and some have even become nodular. The patient reports no other symptoms, and his medical history is notable only for a previous case of visceral leishmaniasis that was successfully treated in his home country five years ago.
What is the probable underlying diagnosis for this patient’s condition?
MRCP2-0979
A 35-year-old man visits the Dermatology Clinic with a complaint of persistent cracking of the skin at the corners of his mouth. He adheres to a strict vegetarian diet. What is the most probable reason for his skin changes?
MRCP2-0980
A 25-year-old healthy man comes to the Dermatology Clinic for a follow-up appointment. He has been using topical topical adapalene and benzoyl peroxide with oral doxycycline for moderate acne vulgaris for 8 weeks. On evaluation, it seems that his acne has not improved and is at risk of scarring. He has no significant medical history. His BMI is 23 kg/m2. Before escalating this patient’s treatment to include oral isotretinoin, what is the first step to take?
MRCP2-0981
A 27-year-old male patient complains of a solitary, painless, hardened sore on his penile shaft that has been present for one week. He also reports feeling several small, painless lymph nodes in his groin area on both sides. The patient admits to having had unprotected sexual intercourse with a prostitute three weeks before seeking medical attention.
What laboratory tests can be done to confirm the diagnosis?
MRCP2-0960
A 68 year old man, originally from India, has been living in the UK for 12 years. He has type 2 diabetes mellitus which is controlled with metformin only.
For the past few years, he has had multiple lumps all over his body, but he hasn’t been too bothered by them as they haven’t gotten worse. He has been seeing the diabetic foot care team due to several non-healing ulcers on his feet.
Recently, he has been feeling increasingly unwell. He has had a fever, pain in his knees and elbows, sore and painful eyes. He also complains of painful swelling in his ring and little fingers on his right hand.
Upon examination, his temperature is 37.8C. His pulse is 91 beats/minute and his RR is 18 breaths/minute. His oxygen saturations are 97% on room air.
He has multiple nodular lesions over his whole body in a symmetrical distribution. The sizes of these nodules range from 2cm – 4cm. These lesions are not painful, and with the larger ones, he is unable to feel you touching them. On his shins, there are several hot painful nodules which are uncomfortable to touch. He has a saddle deformity of his nose. There are several scars on his hands, and an ulcer on the lateral dorsum of his foot. Cardiorespiratory and abdominal examination is essentially normal. Both knees and elbow are slightly erythematous and swollen. He has weakness abducting his little and index finger on his left hand and has no sensation in his left little finger. There is a non-painful 1×4 cm lump two centimetres distal to his left medical epicondyle.
Urinalysis reveals ++ of protein and + of blood. Blood sugar: 8.8 mmol/L
Based on the clinical information provided, what investigation is most likely to confirm the diagnosis?
MRCP2-0961
You are summoned to assess a 27-year-old man who has been admitted to the Neurosurgery Ward for a neurosurgical procedure for almost two weeks. He has been prescribed carbamazepine after the surgery. He is scheduled to be discharged tomorrow, but he has been feeling unwell today and has been complaining of red and painful skin. He has noticed blistering on his arms over the past few hours and also reports mouth soreness. In the last few hours, his pulse rate has increased to 130 beats per minute (bpm). His blood pressure (BP) is 105/62 mmHg. His temperature is 38.3 °C. What intervention is most likely to improve his prognosis?
MRCP2-0962
A 32-year-old man visits his primary care physician complaining of rapidly developing white patches on his skin over the face, trunk, and limbs for the past two months. During the examination, his blood pressure is 110/70 mmHg, and his heart rate is 96 bpm. He experiences postural hypotension. A diffuse swelling is detected in the front of his neck, which moves with swallowing. Upon further investigation, anti-microsomal and anti-thyroglobulin antibodies are found to be positive. Lab Results Normal Range Free T3 (fT4) 6.8 pmol/l 11–22 pmol/l Free T4 (fT3) 2.3 pmol/l 3.5–5 pmol/l Thyroid-stimulating hormone (TSH) 70 µU/l 0.17–3.2 µU/l What would be the appropriate initial treatment for this patient?
MRCP2-0963
A 35-year-old man presents with recurring episodes of guttate psoriasis. He has a history of recurrent tonsillitis, which has triggered several episodes of the psoriasis. Currently, he has developed a post-tonsillitis guttate psoriasis eruption on his trunk and limbs, affecting less than 10% of his body surface area.
What management and prevention options should be considered for this patient with guttate psoriasis?
MRCP2-0964
A 50 year-old woman comes to her GP with a sore on her right shin that has been present for the past 5 months and has been gradually increasing in size. The lesion is tender and has a yellow-brown color. Additionally, there seems to be another smaller lesion growing next to the larger one. The patient has a medical history of type 1 diabetes mellitus and multiple sclerosis, which is currently in remission. She is taking insulin as her only regular medication. What is the best course of treatment for this patient?
MRCP2-0965
A 54-year-old woman presents to the Emergency Department, complaining of changes affecting her left nipple. There is erythema around the nipple with crusting/bleeding and some scaling of the skin over the areola. She has a past history of hypertension and type II diabetes.
On examination, her blood pressure is 130/70 mmHg and pulse 82 bpm and regular. Her body mass index (BMI) is 30 kg/m2. You confirm the findings with respect to the left nipple. There are no palpable masses in either breast, and there is no lymphadenopathy.
What is the most appropriate next step in management?