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3,531 questions
A displaced intra-articular distal radial fracture is being reduced under general anaesthetic and held with a volar plate. What is the best next step in management of this patient?
A 45-year-old lady is having an elective wide local excision of a right breast carcinoma followed by right axillary sentinel node biopsy under general anaesthesia. After 2-3 minutes of injecting the blue dye at the breast tumour site, you notice that the skin overlying the patient's chest has become erythematous. The anaesthetist alerts the surgeon that the patient has become tachycardic. Which of the following is the most appropriate next step to take in the anaesthetized patient?
A 40-year-old man presents with chronic Jumbar back pain, with acute pain radiating down the left leg to his foot. On examination he has weakness of extensor hallucis longus on the left, with diminished sensation over the dorsum of the foot and the lateral side of the calf. What is the most likely diagnosis?
A patient is admitted in haemorrhagic shock following a road traffic accident. A final year medical student places an intravenous cannula; they have inserted a pink (20 G) cannula in the antecubital fossa. What rate of flow into the patient will this allow?
A 42-year-old construction worker is admitted following a crush injury. The patient is in great distress and complaining of chest pain. The patient is working hard to breathe, however there is some paradoxical movement of her chest wall. Arterial blood gases show hypoxia with p02 7.5 and pC02 8.2. A chest radiograph shows multiple rib fractures. The life-saving intervention is?
A 35-year-old man was involved in a motor vehicle collision where he was thrown against the steering column. He sustained a blunt trauma injury to his left upper abdomen. On arrival at the emergency department, he complains of abdominal pain, but is haemodynamically stable. Computed tomography (CT) scanning shows a splenic tear and retained intra-abdominal haematoma. The tear extends through the splenic capsule, but not to the hilum. Which one of the following treatment options is not indicated in this case?
During a ward round, you are asked by your surgical registrar about the management of a phaeochromocytoma. Select from the list below the most appropriate management plan for a phaeochromocytoma?
A homeless man is admitted unresponsive after being found by police on a park bench. He has no external signs of injury. An oesophageal temperature probe records his core body temperature to be 34 °C. Which of the following management options is not routinely indicated in this case?
A 13-year-old girl presents with a rib hump and a coronal curve to the spine. She has no previous past medical history of note. Abdominal reflexes are equal and normal. What is the most likely diagnosis?
A 51-year-old patient is brought into the emergency department following a large-volume haematemesis. The patient is a known cirrhotic and previously survived variceal haemorrhage. The patient is haemodynamically stabilized and an emergency endoscopy is performed which identifies actively bleeding varices, and banding is attempted. Shortly following the procedure the patient again has a large-volume haematemesis and becomes haemodynamically compromised. The next step is?
A 60-year-old patient is being treated for colonic carcinoma. The primary lesion has been excised and chemotherapy started. However, computed tomography (CT) scanning identifies a 1 cm metastasis in the right lobe of the liver. The patient has no history of alcohol misuse or viral hepatitis. CT chest and CT brain show no abnormalities. The most appropriate next stage of management would be?
A 58-year-old man with insulin dependent diabetes presents with chronic erythema and discharge over an ulcerated area located over the first MTPJ of his left foot. CRP is 60 and ESR is 75. Radiographs reveal a destruction of the head of the first metatarsal. What is the most likely diagnosis?
An 85-year-old male patient with a history of chronic constipation presents with acute severe colicky abdominal pain and absolute constipation. Plain abdominal film shows a grossly dilated oval of large bowel arising from the left lower quadrant. A diagnosis of sigmoid volvulus is made. The next step in management is?
: 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 26-year-old woman arrives at the emergency department with unbearable intense right iliac fossa pain. Earlier that day, she was experiencing 'on and off' moderate pain in the umbilical area which gradually moved over to the right iliac fossa. Associated symptoms include anorexia, nausea and vomiting. On examination, the patient is pyrexial and there is rebound tenderness and guarding over the right iliac fossa. A beta-human chorionic gonadotrophin test is negative. What should you do next?
A 38-year-old woman, and mother of two healthy children, is diagnosed with a fluid-filled simple cyst after triple assessment. On ultrasound the inner surface of the cyst looks entirely smooth. The woman does not have any significant family history of carcinoma and the cyst is located in the outer-lower quadrant of the right breast. What would be the most appropriate course of action?
A 48-year-old woman is admitted with severe epigastric pain and vomiting. The pain is continuous in nature and is made worse on movement. On examination you notice the patient is lying still, taking shallow breaths and sweating. There is marked tenderness in the epigastric and right upper quadrant of the abdomen. Murphy's sign is positive and the patient is slightly pyrexial. You suspect acute cholecystitis. What is the next best step in managing this patient?
A 65-year-old man is admitted to the emergency department following an acute episode of abdominal pain and collapse. The pain is intermittent and radiates to the back and iliac fossae. On examination, the patient appears confused, is sweating and has tachycardia. On inspection, the abdomen appears normal, but on palpation, you discover a pulsatile, expansile swelling in the midline of the abdomen. You suspect a ruptured abdominal aortic aneurysm. What is the most important next step?
A 45-year-old man presents with thunderclap headache. He gives a history of longstanding right-side headaches and a rushing sound in the right ear in time with his pulse. What is the most likely diagnosis of this patient?
A 58-year-old postmenopausal woman has been seen in clinic following discovery of a 3 cm, non-tender, irregular, firm lump in the upper outer quadrant of the left breast. Mammography and ultrasound imaging respectively reveal that the lump has areas of calcification and is a solid mass. The most appropriate course of action is?