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3,531 questions
You are asked to see a patient one day post total thyroidectomy who has a serum calcium of 2.0 and is complaining of muscular cramps. Which of the foilowing is the most appropriate next step in this patient's management?
: La sécrétion mérocrine suppose un renouvellement cellulaire pour maintenir l’intégrité de la glande. E : Les glandes séreuses sont les glandes qui synthétisent un produit très épais et qui nécessitent la présence d’une vaste lumière.
A 68-year-old man complains of increasing dysphagia of 3 months duration. He is unable to swallow any solids, and liquids go down with difficulty. He has lost 25 kilogrammes in weight during this period. What should be the first investigation?
A 45-year-old woman sustained a blunt injury to her lower chest and upper abdomen while horse riding. She was brought in with hypovolaemic shock. Having been resuscitated according to the ATLS protocol, she is now stable. What should be the first investigation?
A 72-year-old man, recovering from a stroke, has developed an ulcer over his sacrum over a week. There is also a patch of necrotic skin over his heel. What is the diagnosis of this patient?
A 68-year-old Caucasian man presents with a 3-week history of a swelling at the angle of the right jaw. He denies pain or any other symptoms of note. On further enquiry, he has felt lethargic for the past few months but denies weight loss. On physical examination, he has a 4 cm x 3 cm firm irregular swelling arising from the right parotid gland. He has an asymmetrical smile and is unable to purse his lips to whistle. The most likely diagnosis is?
A 54-year-old woman who is undergoing chemotherapy for breast carcinoma underwent an emergency appendectomy for acute perforated appendicitis 4 days ago. She complains of severe pain in the wound, which shows erythema, oedema, skin blistering and crepitus. What is the diagnosis of this patient?
A 27-year-old patient presents with a 3-month history of increasing difficulty in swallowing. He first noticed the problem when drinking fluids, but is now commonly experiencing it when eating food as well. He has presented as regurgitation off ood is becoming a problem and he has noticed unintentional weight loss. A chest radiograph shows a widened mediastinum. What is the most likely diagnosis?
A SO-year-old woman presents with an acute episode of epigastric pain, vomiting and fever. The registrar, who has already clerked and examined the patient, tells you that 'Murphy's sign is positive'. Despite not having seen the patient, from the information conveyed to you, what is the most likely top differential diagnosis that is running through your mind?
A 6-year-old Asian boy is brought to the paediatric emergency department by his mother. She is worried because the boy is lethargic and has been complaining of right-sided earache all day. There have been no similar attacks in the past. On examination, he looks unwell, and his temperature is 39.0°C, pulse rate is llObeats/min and blood pressure is 90/40 mmHg. There is no cervical lymphadenopathy. Otoscopic examination reveals a bright red right tympanic membrane. You decide to take a microbiology swab. Which one of the following is the most likely pathogen?
A child spontaneously develops a wry neck with a cock robin appearance. What is the most likely diagnosis of this patient?
A rugby player sustains a twisting injury to his left knee during a game and subsequently complains of the knee giving way under him (instability) with episodes of locking. The knee had a significant effusion at the time or injury. X-ray is normal. What is the best next step in management of this patient?
A patient presents to the outpatients department following a car accident in which she has hurt her neck. Since then she has noticed some n11mbness in her right shoulder and neck pain. On examination you note weakness in shoulder abduction, elbow flexion, absent biceps reflex, and paraesthesia affecting the badge area over her right shoulder. The most likely diagnosis is?
A 57-year-old woman is kicked by her horse. She has a large central forehead haematoma and CSF rhinorrhea. What is the most likely diagnosis of this patient?
best statement egarding perioperative management consideration?
A 19-year-old woman fell from her bicycle onto a tarmac road surface. She had abrasions to her left cheek and forehead. The wounds were irrigated with normal saline and she was discharged. She returned 2 months later with several dark patches on her facial skin. What is the most likely diagnosis of this patient?
An 89-year-old woman with multiple medical co-morbidities is admitted after sustaining a fracture of her humerus. The decision is taken not to operate, the arm is placed in a sling and the patient is discharged. The patient re-presents at 3 months after failing to recover normal function in her limb. Radiographs show an absence of callous over the fracture site. The complication is?
A 64-year-old Caucasian woman presents to the emergency department complaining of a 'droopy left eyelid'. She has been a smoker since her twenties (with a 40 pack year history) and drinks between 20 and 25 units of alcohol each week. There is no prior history of neuromuscular disorder. Physical examination reveals clubbing, and a small reactive left pupil. Visual acuity is unaltered and eye movements are normal. An absence of sweating is noticed across the left side of the forehead. Which of the following diagnoses is most likely?
An 80-year-old African American man presents to the emergency department as he has noticed a sudden loss of central aspects of his visual fields. On examination, visual acuity is mildly reduced bilaterally. The central lines on an Amsler chart (grid line chart) appear distorted. The peripheral fields are normal. Fundoscopy reveals multiple retinal infiltrates, but the macula appears normal in size and shape. What is the most likely diagnosis?
A 55-year-old female nurse is admitted with right upper quadrant pain. She undergoes a difficult laparoscopic cholecystectomy. At the end of the operation, a urinary catheter is inserted prior to extubation. Soon afterwards the patient's blood pressure drops to 50/30 mmHg, her heart rate is 170/minute and she becomes difficult to ventilate. What is the most likely diagnosis of this patient?