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3,531 questions
A 32-year-old female patient presents with a 6-week history of bloody bowel motions. She has noticed significant weight loss over the preceding 6 weeks with increasing lethargy and fatigue. She has previously had constipation and admits to regular laxative use. What is the most likely diagnosis?
A 40-year-old patient presents with abdominal pain. He appears unkempt and gives only a vague history. On examination, he is tender over his right iliac fossa where a mass can be felt. The mass is soft and boggy. Compression is possible, which accentuates a similar swelling found below the level of the inguinal ligament. The swelling is not hot or erythematous. On mobilization, the patient complains of severe back pain. The diagnosis is?
A SO-year-old postmenopausal woman with stage 4 invasive ductal carcinoma of the right breast presents with slight shortness of breath. On clinical examination, you notice that the right lung base is stony dull on percussion coupled with decreased air entry. A chest radiograph confirms pleural effusion of the right lung. A chest drain is inserted and some of the drained pleural aspirate is sent for cytological examination and a computed tomography scan of the chest is performed. The results conf"rrm metastatic spread to the lungs. What is the most likely route of metastases that accounts for the pleural effusion?
A 55-year-old man presents with frequency of urine and excessive thirst. He also experiences muscle cramps and has a 5-year history of hypertension that is being managed conservatively. Blood tests show his capillary glucose is 4.1 mmol/L, sodium is 149 mmol/L and potassium is 3.1 mmol/L. The most likely diagnosis is?
A 30-year-old man presents with a 2-month history of swelling in the left testicle that is associated with an occasional dull ache. On examination, it is possible to get above the swelling, but it is not palpable separate to the scrotal contents. In addition, it transilluminates brightly when a light is shone through it. This is likely to be a?
A 36-year-old man presents to the emergency department with a 2-day history of fever, dysuria, frequency and occasional haematuria. He has undergone cystoscopy for investigation of recurrent urinary tract infections 4 days prior to admission. On examination, he is found to be pyrexial with mild tachycardia while rectal examination reveals a swollen, firm and tender prostate gland. Blood tests reveal raised inflammatory markers and a urin.e dip is positive for nitrites. Antibiotics are commenced and a urological opinion is sought for further management. What inflammatory process is this patient likely to have?
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 60-year-old diabetic patient presents with an 8-hour history of being 11nable to pass urine. On taking his history, he reports a 3-day history of pyrexia and throbbing pain around the back passage. He is also concerned as he has also noticed he has been passing urine increasingly frequently and worries that his diabetes is getting worse since increased urinary frequency was how his condition was initially diagnosed. On examination of his abdomen there is no evidence of peritonism. On digital rectal examination there are no abnormalities visible in the perianal area; the procedure is extremely painful. However, the prostate feels normal and is in the normal position. The diagnosis is?
A 36-year-old nulliparous woman attends your clinic with a 7-day history of left breast pain after being involved in a car accident. On examining her breast, you notice a hard, irregular 3 cm, immobile, tender lump. You also notice some skin tethering and overlying bruising in the region of the J11mp. Ultrasound features suggest a benign pathology. The most likely diagnosis at this point is?
A 17-year-old man presents to the emergency department following a stab injury in the mid-portion of his back 1 hour previously. Following initial assessment and stabilization, a neurological examination is carried out, with signs and symptoms suggestive of Brown-Sequard syndrome. All of the following are classical features of this eponymous syndrome except?
A 45-year-old Caucasian woman presents to the outpatient clinic complaining of a central neck swelling. She describes being restless and anxious and is always hot. On examination of the neck you detect goitre. She appears also to have clubbing of her nails. Examination of her eyes reveals injected conj11nctiva, proptosis, and swelling of the eyelids. Her visual acuity is normal, but there is some restriction of her eye movements. What is the most likely diagnosis?
What is the least number of factors that must be present from the modified Glasgow criteria for acute pancreatitis to be classified as severe within 48 hours of admission?
A 21-year-old female law student presents with a painless lump, 3 cm x 2 cm in size, in the upper part of the neck. The lump has been growing slowly for the past several months. On examination, it is soft and fluctuant, does not transilluminate and appears to lie just behind the sternocleidomastoid (SCM) muscle. An aspirate is taken from this lump. The most likely contents are?
A 65-year-old woman of Mediterranean origin presents with a longstanding nodule on her left cheek, which has been present for many months but is becoming increasingly unsightly to USMLE Surgery2e/Diagnostic look at. She is hopeful that it can be treated. On examination, there is a small 0.5 cm x 1 cm round, nodular lesion on the left cheek, the centre of which is collapsed and appears smooth and transparent. The edge of the lesion is rolled and appears 'pearly'. This lesion is likely to be a?
A patient is admitted from the emergency department with new and suddenonset urinary incontinence. The patient has previously been seen in the back pain clinic by the orthopaedic team. On examination you note a large palpable bladder. Neurological examination reveals weakness of knee flexion on the right, plantar flexion of the left and reduced ankle jerks bilaterally. Plantars are downgoing on both sides. You also note patchy mixed sensory loss bilaterally. The diagnosis is?
A 15-year-old boy presents to the surgical assessment unit (SAU) with a 4-hour history of testicular pain that began after he returned home from a school rugby match. The pain began USMLE Surgery2e/Diagnostic initially in the lower abdomen, but quickly progressed to involve the testicles, particularly the right. He has vomited twice prior to arrival and remains nauseous. He is unable to recall any recent injury to the groin. On examination the right testicle appears to lie higher in the scrotum than the left. The scrotal skin is wann and the testis extremely tender to touch. This is likely to be?
An 18-year-old student presents with a 6-month history of a painless lump in her right breast. She is currently mid cycle and does not report any cyclical change in the lump. On examination a 3 cm x 2 cm lump is found in the inner lower quadrant of the right breast as well as a 1 cm x 0.5 cm lump in the upper outer quadrant of the same breast. Both are smooth on palpation and have sharp edges. They slip easily between the examining fingers of the physician. The primary problem is likely to be a?
A 54-year-old male presents to the emergency department with intense left loin to groin pain. Following clinical assessment, he is suspected to have a left-sided renal calculus. This is his second presentation. You are able to look at a previous intravenous urogram of the same patient performed 5 years previous to this presentation. This study is normal, however you notice that the ureters have constrictions along their course to the urinary bladder. From the list below, which one of the following is not considered a physiological site of constriction of the ureters?
A young man who sustained a moderate TBI 3 months previously complains in clinic of persistent headaches and difficulty in concentrating on his studies. Routine bloods are unremarkable. What is the most likely diagnosis of this patient?
A 44-year-old woman presents to the emergency department with acute onset of right upper quadrant pain and fever. On examination, the patient is lying still and has a tachycardia. The abdomen is tender in the right upper quadrant with guarding in that area. Murphy's sign is positive. What is the most useful investigation for this patient?