A 32-year-old woman seeks advice on quitting smoking. She has a 15 pack year history, starting at age 12. She has a 2-month-old baby and wants to protect their health. She has a history of severe postnatal depression and thinks she may have had seizures in childhood. On examination, she has a BMI of 28, blunted affect, and a blood pressure of 138/92. Her investigations are within normal limits except for a slightly elevated creatinine level. What is the most appropriate treatment for this patient?
MRCP2-0711
A 50-year-old woman presents to the haematology outpatient department with unexplained eosinophilia. She has a medical history of recurrent urinary tract infections and systemic lupus erythematosus. Her current medications include nitrofurantoin and azathioprine. Upon examination, she has a rash on her malar region that spares the nasolabial folds. Chest radiography shows no abnormalities. Her blood work shows an Hb of 136 g/L, platelets of 189 * 109/L, WBC of 8.2 * 109/L, neuts of 5.2 * 109/L, lymphs of 2.0 * 109/L, mono of 0.2 * 109/L, and eosin of 0.8 * 109/L. What is the most likely cause of her eosinophilia?
MRCP2-0712
You are the medical registrar on call. The surgical registrar contacts you for a patient he has just seen in clinic who requires an elective cholecystectomy. The patient is a 60-year-old woman who has atrial fibrillation for which she takes rivaroxaban. The patient is otherwise well. The bloods performed in clinic that day are as follows:
The surgical registrar would like to know the duration for which the patient should omit their anticoagulation before the procedure.
MRCP2-0713
A 24-year-old male student presents to the emergency department with a headache which has developed since starting his third year at university studying engineering. He has also been experiencing nausea and shortness of breath. He had spent the summer backpacking through Europe, after which he returned to the UK and moved into shared student accommodation for the upcoming term. He had been healthy during his travels except for a bout of food poisoning in Italy. He has no significant medical history and does not smoke or drink excessively. On examination, he appears fatigued but otherwise well. Chest auscultation is unremarkable. A urinary pregnancy test is negative.
He is started on 15 L of oxygen via a non-rebreather mask. What further management is necessary?
MRCP2-0714
A 20 year old girl is brought to the Emergency Department by a friend. She is a second year university student and her friends are concerned her behaviour has altered in the past few weeks. On assessment she is confused with an AMTS of 6/10. She has a flat affect. Cardiorespiratory examination is normal although the respiratory rate is 22 at rest. Oxygen saturations are 97% on air. Heart rate is 85 bpm regular and blood pressure is 100/55 mmHg.
Examination of her neurological system reveals prominent paraesthesia in both feet with absent vibration sense and proprioception. The ankle and knee reflexes are absent and plantar responses are extensor. There is mild distal weakness in the legs with MRC grading 4/5. Examination of the cranial nerves shows no evidence of nystagmus but visual acuity is reduced to 6/20 bilaterally. She has an ataxic gait.
Her medical history is significant only for coeliac disease and she is taking no regular medications.
The patient’s friend tells you she has recently started using recreational party drugs.
Which of the following inhaled recreational drugs most explains the above picture?
MRCP2-0715
A 16-year-old girl is brought to the Emergency Department by ambulance after her drink was ‘spiked’ at a party. Her friends recall her complaining that she felt like she was having an ‘out of body experience’ and that everything she touched seemed artificial. Over the next hour, she became increasingly distressed, slurring her words and appearing off-balance when walking.
What is the most likely drug that the 16-year-old girl was exposed to after her drink was spiked at a party?
MRCP2-0716
A 63-year-old man with a history of bipolar affective disorder presents at the Emergency Department complaining of feeling unwell for the past two weeks. He initially experienced a coarse tremor in his limbs, which has now progressed to slurred speech and disorientation. Upon examination, he displays an ataxic gait and myoclonus. His lithium level is 2.6, leading to a diagnosis of lithium toxicity. The patient also has a medical history of rheumatoid arthritis, atrial fibrillation, and GORD. Which recent event is most likely responsible for his toxicity?
MRCP2-0717
A 16 year old girl is admitted to the Emergency Department after experiencing a prolonged seizure lasting six minutes. She has a history of epilepsy and has been stable on lamotrigine for the past seven years, with an average of one generalised tonic-clonic seizure every six months. Her mother reports an increase in seizure frequency over the past three weeks, with three generalised tonic-clonic seizures lasting approximately four minutes each. There have been no changes in stress levels, sleep patterns, or diet. However, she recently started taking a new medication for dysmenorrhoea. What is the most likely explanation for this increase in seizure frequency?
MRCP2-0718
A 32-year-old office worker has been brought to the Emergency Medical Unit with severe diarrhoea and vomiting. She reported feeling unwell for the past two days after eating sushi from a local restaurant. Despite receiving an antiemetic injection from the paramedics, she is now experiencing involuntary spasms of her neck and face, with her eyes rolling upwards.
Upon examination, the patient appears distressed and her blood pressure is 140/80 mmHg with a pulse of 90 bpm. She is exhibiting a right-sided torticollis and her jaw is held in spasm.
What is the most appropriate course of treatment to alleviate the patient’s symptoms?
MRCP2-0701
A 32-year-old woman presents to the clinic. She has a 3-year history of rheumatoid arthritis, has been attending the hospital clinic for 8 months and is taking weekly methotrexate with folic acid coverage and diclofenac. For the past few days she has had a sore throat. On examination she is pale and looks fatigued; there are joint changes consistent with active lupus. There is clear evidence of severe pharyngitis. Abdominal examination is unremarkable.