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3,531 questions
A patient who underwent an oesophagectomy in an attempt to cure stage 1 cancer becomes confused 4 days postoperatively and pulls out his nasogastric tube. What is the best course of action?
A 20-year-old footballer is involved in a heavy tackle where another player impacts with outside of his knee. He feels pain over the inner aspect of his knee, and he has a positive valgus stress test but with a firm end point. What is the most likely diagnosis?
A 48-year-old man complains of being intermittently unable to extend his right ring finger, with a clicking sensation sometimes felt. There is a tender swollen nodule over the palmar aspect of the affected finger. What is the most likely diagnosis?
A 78-year-old man presents with severe right groin pain, regular night and rest pain and limiting his day-to-day activities. Radiographs of the hip demonstrate moderate to severe osteoarthritis of the right hip. What is the best next step in management?
: Le pore d'une jonction communicante autorise le passage d'une molécule comme la thymidine kinase par exemple.
A 48-year-old perimenopausal woman presents with a 2-month history of a painful lump in her right breast. On examination you find a 2.5 cm tense, fluctuant, mobile lump in the outer lower quadrant of the right breast. The most appropriate next course of action is?
A patient has a fracture, which is effectively a spondylolisthesis of C2 on C3. What is the most likely diagnosis of this patient?
You are in the vascular surgery outpatient clinic explaining the indications forbundergoing carotid endarterectomy to a patient. From the list below, select the most likely scenario where carotid endarterectomy is likely to be indicated?
A pedestrian sustains a fall from 30 feet, sustaining an open-book fracture of the pelvis. The patient is stabilised and the plan now is for reconstruction. What is the best next step in management of this patient?
A healthy 34-year-old builder presents to his general practitioner having fallen 4.5 m from a ladder 4 days previously, while working at a construction site. Although no major injuries were sustained, since his accident, he has been having near constant lower backache, which radiates down his right leg and is worse on coughing. On examination, the pain is noted to be particularly worse on the outer aspect of the right leg. In addition, there is reduced sensation over this area and the dorsum of the foot. Ankle and big toe dorsiflexion also appear to be weak in comparison to the left side. The patient is referred to the local hospital for an MRI scan, which shows a lateral disc protrusion in the lumbar spine. Which nerve root is likely to be affected in this individual?
A 27-year-old man is hit on his left chin with an elbow during a football game. Later he is unable to bring his teeth together on the right side. There is no fracture. What is the most likely diagnosis of this patient?
A 62-year-old woman underwent a transperitoneal right nephrectomy for carcinoma through a transverse incision 5 days ago. She has not had a bowel action since her operation. Examination reveals a slightly tense distended abdomen with no bowel sounds. Her serum potassium is 2.4mEq/L. What is the d.iagnosis for this patient?
A patient presents to the outpatients department following referral for carpal tunnel syndrome. While taking the history and examining the patient you attempt to evaluate whether any permanent nerve injury has occurred. Which sign is often the first indicator of lasting nerve injury?
A 62-year-old man underwent a coronary artery bypass grafting 8 months ago. The longitudinal scar on his sternum has increased in width, is itchy and is cosmetically unsightly. What is the diagnosis of this patient?
Which of the following syndromes is associated with multiple duodenal ulcers not amenable to conventional medical therapy?
A 74-year-old woman with a BMI of 36 presents with a painful lump around her umbilicus. She has had it for several years and it has increased in size recently. Examination reveals a large, tender, hard, lump over the umbilicus with bluish discolouration and no cough impulse. What is the diagnosis for this patient?
You are asked to see a patient in the outpatient clinic. The patient has weakness in her left arm following a car accident 1 month ago when she fractured her left arm. On examination, there is weakness of extension of the fingers and wrist on the left side. However, the sensation is maintained in all distributions and there is no wrist drop. Which one of the following fractures classically associated with nerve damage is the most likely cause of this palsy?
A 20-year-old man is brought into the resuscitation bay of the emergency department having been involved in a road traffic accident. He is immediately intubated and ventilated as he has a Glasgow Coma Scale score of 4/15 on arrival. You are asked to review his ocular injuries as part of the secondary survey just prior to the computed tomography scan. On inspection, you see a deep horizontal laceration at the inferior aspect of the lower eyelid. Which structure is most likely to be damaged given the pattern of injury?
A patient presents having fallen on his head from a height. The C4 vertebra is fractured and expanded. What is the most likely diagnosis of this patient?
Some 10 days ago, a 60-year-old rescue worker trod on a nail while climbing over wreckage. It passed through the sole of his shoe and into his foot. He did not seek treatment and the wound healed up well. Now he presents with fever, sweating and drooling, and he is unable to open his mouth properly. Each time there is a loud noise, his muscles go into spasm and he seems to be having some difficulty breathing. What is the best diagnosis of this patient?