Archives: MRCP Part 2

MRCP2-0935

A 32-year-old man presents to the clinic complaining of painful and itchy ulcers on his penis for the past 3 days. He also experienced flu-like symptoms in the previous week, dysuria, and a white discharge from his urethra. He had unprotected anal sex with a casual partner 12 days ago.

During the examination, the doctor observed three tender, shallow ulcers under the foreskin, along with redness of the surrounding skin. The urine dipstick test was normal. The urethral swab microscopy showed the presence of pus cells.

Which test is most likely to provide a definitive diagnosis?

MRCP2-0936

You are requested to evaluate a 23-year-old female patient in the Dermatology Clinic who has a medical history of epilepsy and learning difficulties. She is currently taking various antiepileptic drugs (AED) and mood stabilisers. During the examination, you notice a rash on her lower limbs that comprises several erythematous indurated papules and nodules. Upon conducting a biopsy of the lesions, you find significant T-lymphocyte infiltration. What is the probable diagnosis for this patient?

MRCP2-0937

A 32-year-old man comes to the Dermatology Clinic with an expanding 7 cm hardened, depigmented patch at the navel that emerged soon after he got his belly button pierced two years ago. He is worried because it seems to be growing and he can no longer wear any jewelry in that area. He has no other skin abnormalities anywhere else and no other health issues. He does not take any regular medications and has no allergies. He smokes 15 cigarettes per day and drinks alcohol occasionally.

What is the most probable diagnosis?

MRCP2-0938

A 29-year-old man presented to the dermatology clinic with a scaly rash on his arms and legs, mainly affecting his knees and elbows. The rash had been present for four weeks. He had a medical history of hypertension and had been prescribed furosemide and ramipril by his GP six months ago. Additionally, he had a long-standing bipolar disorder and had been taking lithium for three months, having previously taken chlorpromazine for five years. He had also received a course of oxytetracycline for acne six weeks ago. Which medication is most likely responsible for the rash?

MRCP2-0939

A 65-year-old man with a history of renal transplant visits the dermatology clinic. He presents with a scaly nodular lesion on his left forearm, measuring 7mm, with an inflamed red base. This lesion resembles two squamous cell skin carcinomas that were previously excised. The patient reports no pain and has no lymphadenopathy.

The patient is currently taking tacrolimus, although the dose was lowered after his last squamous cell carcinoma excision. He also has well-controlled hypertension, managed with ramipril. His blood test results are as follows:

– Hb: 120 g/l
– Platelets: 308 * 109/l
– WBC: 6 * 109/l
– Neuts: 4 * 109/l
– Na+: 136 mmol/l
– K+: 4.9 mmol/l
– Urea: 5 mmol/l
– Creatinine: 98 µmol/l

What is the most appropriate course of action for managing this patient’s condition?

MRCP2-0940

A 30-year-old man presents to his GP complaining of genital pruritus and painful intercourse with his partner. Upon examination, a white plaque is observed on his phimotic foreskin, along with a whitish scarred meatus. What is the probable diagnosis?

MRCP2-0941

A 30-year-old woman comes to the clinic with a 6-week history of an ulcer on the back of her right hand. The lesion initially appeared as a painful nodule measuring 1 cm in size and gradually increased in size. Currently, it is a firm raised purple/red lesion with central ulceration, measuring 3cm in diameter. She denies having any other lesions and reports feeling well. She has no significant medical history and has not traveled outside of the UK in the past 5 years. Although she works in a pet shop that specializes in tropical fish, she does not have any pets.

What is the most probable causative organism responsible for this lesion?

MRCP2-0942

A 31-year-old man with autism spectrum disorder visits the general medical clinic due to a severe eczema flare that has not been controlled with emollients, strong topical corticosteroids, and non-sedating antihistamines. He has no other medical issues but is anxious about the spreading rash. During the examination, spreading erythema is observed from flexural folds on his arms and legs. What is the best course of treatment to pursue while waiting for a dermatology appointment?

MRCP2-0943

A 55-year-old man presents to the Emergency Department (ED) with an enlarging rash over his shin, which was associated with significant swelling and discomfort. Six days earlier, he had undergone a surgical procedure to his varicose veins.

On examination, he is sweaty and anxious. He has a low-grade fever and tachycardia of 130 beats per minute (bpm). His blood pressure (BP) is 120/80 mmHg.

There is an extensive brownish red discoloration over the whole shin and significant associated swelling. There is also a crackly sensation when the swollen area is palpated, and a pungent discharge from an open site at the distal end of the affected area.

What is the most important treatment option?

MRCP2-0944

A pair of siblings from a Nordic lineage, aged 21 and 24, come to the Cancer Genetics Clinic seeking advice. They are anxious because four female members of their family have had breast cancer in their 40s, and 7 out of 12 of their aunts and cousins have been diagnosed with malignant melanomas. What gene mutations or proteins could be accountable for this?