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3,531 questions
A 33-year-old man travels to South Africa to take part in a safari. On arriving, the patient takes his antimalarial tablets. A few days into his course he becomes ill complaining of shortness of breath, pallor and bloody urine. Blood tests reveal anaemia and reduced haematocrit, while a blood smear shows the presence of Heinz bodies. The most likely diagnosis is:
A 65-year-old man presents with a chronic history of malaise, shortness of breath and paraesthesia in his hands. He appears tired and pale while speaking and on examination his heart rate is 115, respiratory rate 16. A Schillings test is positive while blood tests reveal a macrocytic anaemia and a Coombs test is negative. The most likely diagnosis is:
A 47-year-old woman presents to clinic concerned about her recent ill health. She bas noticed over the last three months that she has been suffering from headaches, fatigue and recurrent infections. She notes she has rarely been to the doctor before and otherwise leads a healthy lifestyle. She decided to see a doctor when she noticed petechial rashes appearing on her arms. USMLE IM2e/Diagnostic On examination there is no organomegaly and blood tests reveal an MCV of 105, a pancytopenia with the bone marrow appearing hypocellular on biopsy.
A woman on the labour ward has just had a normal birth. At birth there was a lot of meconium present. The newborn did not respond initially but did after subsequent resuscitation. The midwife records the Apgar score as 5. Which of the following best describes the categories an Apgar score is created from?
A 65-year-old man presents to you reporting he has become increasingly worried about his lack of energy in the last 2 weeks. He mentions he has been increasingly tired, sleeping for long periods and has suffered from fevers unresponsive to paracetamol. He became increasingly worried when he noticed bleeding orginating from his gums. A blood ftlm shows auer rods, hypogranular neutrophils and stains with Sudan black B. The most likely diagnosis is:
A 66-year-old woman complains of stiffness and weakness climbing stairs. She has a history of hypertension and diet--controlled type 2 diabetes. On examination, there is mild upper arm weakness, hip flex.ion is 4/5 bilaterally, with bilateral wasting and flickers off asciculations in the right quadriceps. Knee extension is 4/5. Dorsiflexion and plantar flexion are strong. Brisk knee and ankle reflexes are elicited, as well as a positive Hoffman's and Babinski's sign. Sensory examination and cranial nerves are normal. Her BM is 8.9, her pulse is regular and her blood pressure is 178/97. What is the most likely diagnosis?
A 78 year old right-handed male collapses and is brought into accident and emergency. He seems to follow clear one-step commands but he gets very frustrated as he cannot answer questions. He is unable to lift his right hand or leg. He has an irregularly irregular pulse and his blood pressure is 149/87. He takes only aspirin and frusemide. What is the most likely diagnosis?
A 71-year-old man with atrial fibrillation is seen in clinic following an episode of syncope. He describes getting a poor night's sleep and, as he got out of bed in the morning, feeling dizzy for a couple of seconds before the lights dimmed around him. He was woken a couple of seconds later by his wife who had witnessed the event. She says he went pale and fell to the floor and his arms and legs jerked. After waking, he was shaken but was 'back to normal' a few minutes after the event. His medication includes aspirin, atenolol and frusemide. What is the most likely diagnosis?
A 41-year-old man complains of terrible headache. It started an hour ago, without warning, while stressed at work. It affects the right side of his head. He scores it '11/10' in severity. When asked, he agrees that light does bother him a little. He had a similar episode six months ago, experiencing very similar headaches over 2 weeks which resolved spontaneously. On observation, he looks quite distressed and prefers to pace up and down, unable to sit still. What is the diagnosis?
A 49-year-old man complains of sudden onset, painless unilateral visual loss lasting about a minute. He describes 'a black curtain coming down'. His blood pressure is 158/90, heart rate 73 bpm. There is an audible bruit on auscultation of his neck. His past medical history is insignificant other than deep vein thrombosis of his right leg ten years ago. The most likely diagnosis is:
A 69-year-old man presents to clinic with a six-month history of progressive lower back pain which radiates down to his buttock. He found the pain was exacerbated while taking his daily morning walk and noticed that it eased going uphill but worsened downhill. He stopped his daily walks as a result and he now walks only slowly to the shops when he needs to, taking breaks to sit down and ease the pain. He has a history of hypertension, diabetes and prostatic hyperplasia. What is the diagnosis?
A light is shone into a patient's right eye and it constricts. When moved to the left eye, the left eye constricts. When moved back to the right eye, the right eye dilates. What is the diagnosis?
A 55-year-old woman complains of double vision. She finds that she is tired all the time and has difficulty climbing stairs. She has difficulty getting items off high shelves at work. Reflexes are absent but elicited after exercise. Shoulder abduction is initially 4-5 but on repeated testing is 4 +/5. What pathology is associated with this female's diagnosis?
A 16-year-old presents to the termination of pregnancy service 6 weeks into her second pregnancy requesting surgical termination (STOP). What is not required as part of her work-up for the procedure?
A 69-year-old man is taken to his GP by his concerned wife. She complains that he has not been himself for the last year. He has slowly become withdrawn and stopped working on his hobbies. Now she is concerned that he often forgets to brush his teeth. She has noticed he sometimes struggles to find the right word and this has gradually become more noticeable over the last couple of months. She presented today because she was surprised to come home to find him naked and urinating in the living room last week. He has a history of hypertension and is an ex-smoker. The most likely diagnosis is:
A 43-year-old woman presents with dizziness to accident and emergency. It started suddenly this morning, she awoke with a headache and the dizziness started when she sat up in bed. She describes the room spinning for a couple of minutes. It settles if she keeps still, but returns on movement. There is no tinnitus or deafness, but some nausea and no vomiting. The most likely diagnosis is:
A 45-year-old man presents with a 5-day history of progressive tingling and numbness of his hands and feet. He insists that he has never had this problem before and that he was perfectly fine a week ago. Over the last 2 days he has had some difficulty walking but mostly he complains about difficulty rolling up cigarettes. On examination, there is mild symmetrical distal weakness, mild gait ataxia and dysdiadochokinesia. He smokes 30 cigarettes a day and drinks 1-2 bottles of wine. He has a family history of hypertension and his 63-year-old mother has type 2 diabetes, whom over the last year has complained of numbness and burning in her feet. He self-discharges. A week later, his symptoms have peaked. He displays moderate distal wea.kness and numbness to his knees, after which he turns a corner and his symptoms start to slowly resolve. What is the diagnosis?
A 28-year-old junior doctor has been complaining of a headache for the last 24 hours. It started gradually, intensifying slowly and involving the entire cranium, but over the last couple of hours she has noticed that turning her head is uncomfortable. She feels generally unwell and prefers to lie in a dark room. Her boyfriend has noticed that she seems irritable. On examination, she exhibits photophobia and there is neck stiffness. There is no papilloedema. Close examination of her skin reveals no rashes. Kernig's sign is negative. A lumbar puncture (LP) reveals low protein, normal glucose and lymphocytosis. What is the diagnosis?
A 36-year-old woman presents to clinic with neurological symptoms. On examination, she is able to stand with her feet together. Upon closing her eyes, however, she is unable to keep her balance. What is the diagnosis?
A 60-year-old man has presented to the gastroenterology outpatient clinic with a four-month history of progressive dysphagia. The patient reports a weight loss of 9 kg in the same time period. He has suffered from gastro-oesophageal reflux disease for the past 10 years. At endoscopy, a 5 cm malignant stricture is seen at the lower end of the oesophagus and biopsies are taken. Histological analysis is most likely to reveal: