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3,531 questions
A 76-year-old woman complains of an ulcer in the region of her medial malleolus for 6 months. She has had a swollen leg for many years foilowing a deep vein thrombosis, which she suffered after childbirth. What is the diagnosis of this patient?
A 28-year-old man while working on a building site sustained a fracture of his tibia and fibula having fallen from a ladder. This was promptly treated by open reduction and internal fixation. On the second postoperative day, he developed severe pain in his leg exacerbated by passive movement and sensory loss. What is the diagnosis of this patient?
A 6-year-old child with cerebral palsy is toe-walking and is referred for assessment and management to aid her to walk on the soles of her feet (plantigrade). What is the most likely diagnosis?
: Le pore d'une jonction communicante autorise le passage d'une molécule comme la thymidine kinase par exemple.
A 30-year-old man sustained an injury at a building site when a heavy piece of masonry fell on his lower abdomen. He is tachypnoeic and in hypovolaemic shock, with a pulse of 130/minute and a blood pressure of 80/60 mmHg. He has been resuscitated by the ATLS protocol and is stable after 4 hours, has a pulse of 100/minute, blood pressure of 130/90 mmHg and CVP of 4 cm H20. He continues to be short of breath, with an oxygen saturation of 92%. He bas an indwelling catheter, two IV cannulae with crystalloids and blood and a nasogastric tube. A chest x-ray shows the tip of the nasogastric tube next to the heart in the left chest. What is the most likely diagnosis of this patient?
A 9-year-old boy sustained a kick in the left side of his abdomen and loin while playing rugby. After a brief period of rest, he finished his game. In the changing room when he passed urine, it was haematuria. He was brought to the A&E department. He was stable with a pulse of 90/minute and blood pressure of 110/80 mmHg. On examination he had bruising over the left lumbar region and left loin with some obliteration of the loin curve. What is the most likely diagnosis of this patient?
A 15-year-old girl presents with pain at the base of the second toe. Radiographs demonstrate an abnormal second metatarsal bead with flattening. What is the most likely diagnosis?
Following a severe RTA, a 35-year-old female passenger in the back seat of a car had to be extricated. She has been brought in with generalised abdominal pain across the site of the seat belt. She is breathless and complaining of pain in the left upper quadrant and left shoulder, which had impacted against the front seat. Her pulse is 110/minute and blood pressure is 100/60 mmHg. She is very tender over the left upper quadrant and clinically there is no shoulder injury. She has fracture of her left 9th, 10th and 11th ribs. What is the most likely diagnosis of this patient?
A fit 35-year-old man fell from a second floor balcony and sustained a severe blunt upper abdominal trauma. He had a splenectomy for ruptured spleen and partial hepatectomy for torn liver. On the third postoperative day he became oliguric, had cardiorespiratory compromise, type 2 respiratory failures and gross abdominal distension. What is the most likely diagnosis of this patient?
A frail 75-year-old woman, ASA category 3, underwent an Ivor Lewis with pain control managed with an epidural. On the first postoperative evening, the nurses have been worried as USMLE Surgery2e/Diagnostic the patient has been agitated and confused. They call you urgently following an epidural top up, as the patient is convulsing. What is the most likely diagnosis of this patient?
A 35-year-old woman underwent an emergency appendicectomy for acute perforated appendicitis. Having had an uneventful appendicectomy and being discharged home after 2 days, she returned to hospital 1 week later feverish with a temperature of 41°C, lower abdominal pain and a tachycardia. She looks ill and toxic. What is the most likely diagnosis of this patient?
A fit 28-year-old motorcyclist involved in a road traffic accident was admitted with a femoral fracture and a fracture-dislocation of his elbow treated by internal fLXation. On the second USMLE Surgery2e/Diagnostic postoperative day be is hypoxic, confused, and agitated and has developed a petechial rash. What is the most likely diagnosis of this patient?
A 22-year-old patient is brought to the emergency department in class III shock following multiple penetrating stab injuries to the torso, chest and abdomen. He undergoes an emergency thoracotomy and laparotomy. In theatre, he requires a total of 30 units of blood. Which of the following is the best statement regarding complications of massive blood transfusion?
A patient is commenced on total parenteral nutrition. You are asked by the nutrition team to ensure that adequate monitoring takes place. Which one of the following statements regarding monitoring of total parenteral nutrition is most correct?
You are asked to see an SO-year-old female patient who is 2 days post insertion of a right dynamic hip screw following an extracapsular right neck of femur fracture. She has become acutely short of breath with a respiratory rate of 28 breaths per minute. The oxygen saturations are 96% on 5 litres of oxygen per minute. Her pulse rate is 120 beats per minute, blood pressure is 110/70 mmHg and body temperature is 370C. Examination of the chest is normal. You perform an arterial blood gas investigation. From the list below, choose the most likely type of acid-base disturbance you expect to see from the arterial blood gas results?
You are asked to see a 35-year-old man who sustained a head injury during a road traffic accident. The patient was stable upon arrival to the emergency department, but over the last hour, his GCS has fallen from 15/15 to 13/15 and he is now drowsy and complaining of a headache. From the list below, choose the most appropriate next step to take in this patient's management?
A 40-year-old man is admitted to the Intensive Care Unit following a diagnosis of severe pancreatitis. The patient develops acute respiratory distress syndrome. Which of the following is associated with the diagnostic criteria for ARDS?
A 68-year-old woman presents with a painless but progressively weak shoulder. She can only abduct it with a trick movement hunching her shoulder. Otherwise, there seems to be very little power of abduction. What is the most likely diagnosis?
A patient has a hyperextension injury. X-ray shows a small chip of bone off the front of a vertebral body next to the disc space. What is the most likely diagnosis of this patient?
A 68-year-old man is 6 days following open anterior resection with defunctioning ileostomy. The patient is afebrile at 36.7 °C. He is eating and drinking normally. The nursing staff informs you the stoma output is 3 L/day. His mucous membranes are dry and the patient feels thirsty. Which one of the foilowing statements regarding fluid therapy is most correct?