Archives: MRCP Part 2

MRCP2-0921

A 30-year-old man visits his GP complaining of multiple small ‘spots’ on his right hand. He reports that these ‘spots’ have been present for a few months and have increased in number. The patient is confident that there was only one initially, but adjacent fingers became involved over time. He is in good health and not taking any medications. On examination, the hand shows several skin-coloured exophytic nodules that are not inflamed. There is minimal scaling, but the lesions tend to be found on adjacent skin surfaces. What is the most probable diagnosis?

MRCP2-0922

A 40-year-old man presents to the medical clinic with severe eczema that has flared up over the past two weeks. Despite using emollients and hydrocortisone 1%, he has experienced worsening flexural irritation and pruritus. He denies any systemic symptoms and has a past medical history of asthma and hay-fever, for which he rarely needs his salbutamol inhaler. He is not taking any oral medications. The patient has a previous dermatology appointment letter that recommends a short course of a moderate topical steroid if his eczema remains poorly controlled. What is the most appropriate prescription for him?

MRCP2-0923

A 25-year-old woman comes to the clinic complaining of a tingling sensation in her lower limbs and seizures that have been occurring for the past year. She reports having decreased visual acuity and sensitivity to light since childhood, as well as a history of frequent respiratory infections and easy bruising after minor injuries.

During the examination, the doctor notices multiple patches of depigmentation on the woman’s face, trunk, and limbs, as well as silvery hair. A peripheral smear reveals an accumulation of large granules in her neutrophils.

What is the most likely diagnosis for this patient?

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?