Archives: MRCP Part 2

MRCP2-0924

A 25-year-old female patient with psoriasis is seen at your Dermatology Clinic. She has tried various creams and undergone multiple courses of ultraviolet B (UVB) therapy, but her condition persists. During the consultation, she expresses her frustration and tearfully explains how psoriasis is affecting her social life and self-esteem. She is hesitant to consider systemic therapies that may compromise her immune system. You suggest acitretin as a potential treatment option and inquire about her plans for having children. She responds that she is currently in a relationship but has no immediate plans for starting a family. What is the recommended duration of contraception after taking acitretin?

MRCP2-0925

A 38 year old Caucasian male visits a clinic after spending three months in Jamaica on a yoga retreat by the beach. He was careful to only consume bottled water and well-cooked vegetarian meals, and made sure to peel any raw vegetables. He returned home three weeks ago. During his last week in Jamaica, he noticed an itchy spot on the side of his ankle. The rash has been slowly spreading from the original spot, resembling a snake-like shape up the side of his foot. The lesion is currently 11 cm long and is a raised, itchy, serpiginous linear lesion. He reports feeling otherwise healthy. What is the organism responsible for this condition?

MRCP2-0926

A 50-year-old man presents with a skin rash after returning to the UK following a 6-month stay in Sudan. He reports sustaining multiple fly bites during his travels, with some of the bites becoming raised red bumps that turned scabby and painful. Unfortunately, the majority of these have not healed.

During the examination, the clinician notes atrophic scars on the patient’s cheeks, arms, and ankles. Additionally, there are raised scaly lesions with interspersed erythematous ulcerated papules, some of which are oozing pus in the same distribution.

What is the typical diagnostic tool used to confirm the likely diagnosis?

MRCP2-0927

A 73-year-old woman visits her GP to receive the findings of her recent gastroscopy and barium enema. She also reports a rash in her armpit. During the examination, the GP observes thickened, velvety, pigmented areas in both axillae. What could be the probable outcome of her tests?

MRCP2-0928

A 34-year-old patient presents with a 5-month history of recurring abdominal discomfort, nausea, and vomiting. The patient denies any previous gastrointestinal symptoms and reports no recent travel or consumption of unusual foods. The patient’s diarrhea is watery, and there is no presence of blood in the stool. The patient had a bone densitometry scan eight months ago, revealing a T-score of <-2.8 after breaking their hip and both femurs while playing football. During the examination, the physician notices brown papules on the patient's lower legs, measuring 2 to 3 mm. When pressed, a red raised line is elicited on the lesion and surrounding skin. The patient also has hepatosplenomegaly. The patient's admission blood tests show a low Hb level, normal platelet count, low WBC count, high ESR, normal sodium and potassium levels, high adjusted calcium levels, low phosphate levels, high CRP levels, and high serum tryptase levels. Complement, C1 inhibitor, serum gastrin, and 24-hour urinary 5-HIAA levels are all normal. What is the most likely diagnosis that unifies these symptoms?

MRCP2-0929

A 28-year-old woman came to the clinic complaining of a severely itchy rash that has been present for 2 years. She was diagnosed with HIV infection 4 years ago and is not currently taking any medications. Upon examination, there are numerous papules and pustules that have been scratched open on her chest, back, and the backs of her arms. Her CD4+ count is 290 × 106/l (normal range: 430 – 1690 × 106/l). What is the most probable diagnosis?

MRCP2-0930

A 45-year-old African American man presents to the Neurology Clinic with a 7-month history of distal sensory loss and weakness. He has no history of headache or visual changes and his co-ordination remains intact. He denies any constitutional symptoms or recent infections. He has a past medical history of diet-controlled type II diabetes and hypertension, and takes ramipril 5 mg once daily. On examination, he has visible wasting in the intrinsic muscles of his left foot, with a Medical Research Council (MRC) power of 4/5 for ankle dorsiflexion. There is associated loss of temperature and light touch sensation down the posterolateral aspect of his left leg. The remainder of his neurological examination shows no further motor deficits and his cranial nerves are intact. He has multiple hypopigmented patches over the extensor surfaces of his arms and legs, with associated sensory loss for all but deep pressure stimuli. What is the most appropriate investigation to confirm the diagnosis?

MRCP2-0931

A 27-year-old male with a history of epilepsy presents with a fever and rash. He has been experiencing difficulty controlling his seizures and has recently started taking carbamazepine and valproate. Over the past week, he has developed a painful, diffuse erythematous rash that appears to slide laterally upon palpation. In addition, he has blistering and inflammation in his oral cavity. What is the probable diagnosis?

MRCP2-0932

A 32-year-old man visits her GP with a complaint of a rash in his groin area. He recently returned from a beach vacation and had used a cream recommended by a local pharmacist to treat the rash. However, the rash has only worsened since then. The patient reports that the rash is itchy and painful.
Upon examination, the rash appears as a scaly and raised border with a sharp red outline. It spreads asymmetrically in the area but does not involve the scrotum. The rash is slightly raised and has a clearer center.
What would be the most appropriate clinical investigation, if any, to aid in the diagnosis?

MRCP2-0933

A 32-year-old male patient arrives at the Emergency Department (ED) with a complaint of painful genital sores that have been present for three days. He reports experiencing discomfort while urinating and flu-like symptoms, including myalgia and a low-grade fever.
During the examination, multiple small, white painful ulcers are observed throughout the genital area. The patient also has tender lymph nodes in the inguinal region.
A swab is taken of the ulcers, but while waiting for the results, what is the most appropriate next step?