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3,531 questions
A 30-year-old Afro-Carribean woman presents to accident and emergency with a 1-week history of progressive shortness of breath and fever. On further questioning, she mentions that her hands have been painful and stiff over the past few months and she has been having recurrent USMLE IM2e/Diagnostic mouth ulcers. Chest x-ray confirms bilateral pleural effusions and blood tests reveal a raised ESR and a normal CRP. What is the most likely diagnosis?
A 34-year-old Afro-Carribean woman has been admitted for management and investigation of increasing shortness of breath. On further questioning, she mentions that her hands have been painful and stiff over the past few months and she has been having recurrent mouth ulcers. Chest x-ray confirms bilateral pleural effusions and blood tests reveal a raised ESR and a normal CRP. A diagnosis of systemic lupus erythematosus (SLE) is suspected and a full autoantibody screen is sent to the laboratory. Which of the following auto-antibodies is most specific to the suspected diagnosis?
A 27-year-old woman presents to accident and emergency complaining of sudden onset shortness of breath, right-sided pleuritic chest pain and haemoptysis. She has a past medical history of three miscarriages and a deep venous thrombosis in the right leg. CTPA confirms a large pulmonary embolism. What is the most likely underlying diagnosis?
A 45-year-old woman presents to the rheumatology clinic with a three-month history of itchy, dry eyes and a persistently dry mouth. She also mentions that her fingers have been extremely cold, occasionally turning blue after going outside in the morning. Shirmer's test is positive. What is the most likely diagnosis?
A 30-year-old woman presents to accident and emergency with worsening stiffness in the hands, wrists and feet. She mentions that the pain has been particularly bad in the mornings. On USMLE IM2e/Diagnostic examination, there is a palpable spleen. Initial blood tests reveal a low neutrophil count and a raised C-reactive protein. The most likely diagnosis is:
A 53-year-old man, who works as a chef, presents to accident and emergency with sudden onset severe pain, tenderness and swelling of the first metatarsophalangeal joint. The pain is making it difficult for him to mobilize. He has had two previous similar episodes. Blood tests reveal a raised serum urate level. The most likely diagnosis is:
A 30-year-old Turkish man presents to accident and emergency with oral ulcers, genital ulcers and painful legs. On examination, there are apthous ulcers in the mouth, genital ulceration, erythema nodosum over the shins. He is admitted under the medical team on call and a skin pathergy test is positive. What is the most likely diagnosis?
A 67-year-old man presents to his GP with pain in his pelvis. During the consultation, he mentions that his friends have been commenting that his head appears larger than before. In addition, he has noticed deterioration in hearing in his left ear. On neurological examination, a left-sided sensorineural deafness in detected. Closer inspection of the legs reveals bowing of the tibia. What is the most likely diagnosis?
A 16-year-old boy presents to his GP complaining of nosebleeds and bleeding after brushing his teeth. He is unsure of how long this has been occurring but decided to seek advice after having to continually excuse himself from lessons. On examination you notice he has some skin bruises. A blood test shows a prolonged bleeding time and activated partial thromboplastin time (APTT), while platelet count and prothrombin times are all normal. The most likely diagnosis is:
A 22-year-old Caucasian woman presents with a 1-day history of a painful right leg which is erythematous on appearance and tender on palpation. She states that she has had this problem many times in the last few years and her family has also suffered from similar problems. Her grandmother died of a pulmonary embolism. The most likely diagnosis is:
A 44-year-old Asian female presents with a two-month history of shortness of breath and lethargy. She denies any intolerance to the cold or any changes in her weight and on examination appears slightly pale. She states that she has recently become a vegetarian. A blood film shows the presence of elliptocytes and blood results show the following: Haemoglobin 9.9 g/dL, Mean cell volume (MCV) 75 fL, Ferritin Low. The most likely diagnosis is:
A 47-year-old teacher complains of difficulty maintaining her concentration at work teaching secondary school children. She states that over the last four months she has become increasingly tired and easily fatigued. She has noticed it has become more difficult for her to lift books, rise from her chair and she has also noticed a tingling sensation in her fingers. Examination shows a positive bahinski sign and absent reflexes. A blood test reveals the following: Haemoglobin 10 g/dL, MCV 103 fL. The most likely diagnosis is:
A 55-year-old man complains of a 4-week history of general malaise and fatigue, he has also noticed his trousers have become more loose fitting. A blood test shows the following results: Haemoglobin 12 g/dL, MCV 90 fL, Platelet count 250 x 109/L, WBC 10 x 109/L, Serum iron 10 µmol/L, Total iron-binding capacity 40 µmol/L, Serum ferritin 160 µg/L. The most likely diagnosis is:
A 45-year-old man collapses at home and is brought to accident and emergency. He has a fever at 39.5°C and blood pressure is 90/60 mmHg, although he is in a lucid state. Bruises can be seen on his skin which he remembers being present before he fell. Blood tests show the patient to have a normocytic anaemia with a low platelet count and increased fibrin split products. The most likely diagnosis is:
A 23-year-old Asian man presents to his GP complaining of shortness of breath following exercise. He has always been a little unfit and decided to start going to the gym but noticed that even after 4 weeks he is still quite short of breath. He denies any coughing or wheezing and on examination you notice mild pallor but the patient says he has always been slightly pale in colour. Investigation results are given below: Haemoglobin 12 g/dL, MCV 70 fL, Serum iron 14 umol/L, Ferritin 60 ug/L, Transferrin saturation 35 per cent, Mean cell haemoglobin 22 pg, Haemoglobin electrophoresis HbA2 increased. The most likely diagnosis is:
A 65-year-old woman suffers significant bleeding during a difficult bowel resection and is prescribed three units of blood after the operation is completed. It is the first time she has required a blood transfusion and her details are checked carefully. Approximately 4 hours after the transfusion the patient feels acutely unwell and complains of fever, chills and a dry cough. Blood pressure is 110/80 mmHg, temperature 38°C and oxygen saturation is 94 per cent. The most likely diagnosis is:
A 52-year-old woman presents complaining of a two-month history of increasing fatigue and numbness in both of her arms and legs. She lives at home with her husband and has found it difficult coping with the daily activities of living. She suffers from hypothyroidism which is well controlled with thyroid replacement medication. A peripheral blood smear shows hypersegmented neutrophils. A blood test reveals the following: Haemoglobin 10 g/dL, Mean corpuscular volume 110 fL, Platelets 150 x 109/L. Liver function tests: ALT 25 IU/L, AST 27 IU/L, GGT 22 IU/L, ALP 100 IU/L, Urea 5 mmol/L, Creatinine 100 µmol/L. The most likely diagnosis is:
During a busy ward round you are asked to visit a patient the consultant has not had an opportunity to see. The only details you are given are that the patient is female and was admitted the previous day with bleeding abnormalities, you are given the results of her blood investigations: Prothrombin time Unaffected, Partial thromboplastin time Prolonged, Bleeding time Prolonged, Platelet count Unaffected. What is the most likely diagnosis?
A 14-year-old girl is brought to clinic by her parents who have been worried about a fever the patient has had for the last week. The patient looks pale and unwell. Blood tests reveal a neutropenia with normal red blood counts (RB Cs) and platelets. A bone marrow exam reveals USMLE IM2e/Diagnostic no abnormalities. The patient bas been otherwise fit and well. There is no organomegaly or lymphadenopatby. The most likely diagnosis is:
A 65-year-old man presents with a chronic history of headaches and occasional dizziness. He hesitantly mentions that he experiences severe pruritus, especially after hot showers and baths. Blood pressure is 160/85 mmHg. A full blood count (FBC) reveals a haemoglobin of 20 g/dL, MCV of 94 fL, platelet count of 470 x 109/L and WBC count of 7.8 x 109/L. The most likely diagnosis is: