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3,531 questions
A 45-year-old man presents to the emergency department with a history of coffee-ground vomiting. He also reports that for 2 days his stool appeared darker than usual. Which of the following gives the most sensitive guide as to the severity of his gastrointestinal haemorrhage?
A 45-year-old patient presents in shock complaining of sudden-onset generalized upper abdominal pain radiating to the right iliac fossa and the tip of his right shoulder. He reports one episode of vomiting, but none since. He has no past medical problems. On examination, his abdomen is rigid and bowel sounds are absent. The diagnosis is?
A 29-year-old patient presents with a short history of right upper quadrant pain. She is jaundiced with dark urine and pale stool. She has a fever of 38.9 °C. Abdominal examination gives no suggestion of a palpable gallbladder. The diagnosis is?
You are called to see an 85-year-old female patient as the nursing staff is concerned that the patient has not passed stool for 4 days. The patient has been admitted after family members became increasingly concerned regarding her general deterioration in health and level of function. She is orientated but frail and complains of increasing abdominal discomfort. On examination bowel sounds are increased. The abdomen is distended with generalized tenderness, but no rebound or guarding. There is a firm palpable mass in the left iliac fossa. Digital rectal examination shows an empty rectum. What diagnosis must be excluded?
A 60-year-old homosexual man presents with a 6-month history of passing fresh blood per rectum and anal pain. His presentation has been precipitated by the recent loss of continence to faeces. The blood coats the stool and he had noticed it on the paper after wiping. On rectal USMLE Surgery2e/Diagnostic examination the patient has an empty rectum. You identify a third-degree haemorrhoid in the 11 o'clock position, as well as two further second-degree haemorrhoids. No other masses are palpable. The diagnosis is?
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?
: Chez l'adulte, on observe de très nombreux groupes isogéniques coronaires au niveau du cartilage de la trachée.
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?
: Le cartilage fibreux est préférentiellement observé au niveau des zones où les forces mécaniques sont peu importantes.
Five days after sustaining a moderate TBI, a patient's routine bloods reveal a serum sodium of 124 mEq/L. Clinically, the patient is euvolaemic. What is the most likely diagnosis of this patient?
A patient sustains a flexion distraction injury at the thoracolumbar junction following a highspeed road-traffic accident where he was wearing a seat belt. 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 45-year-old Asian man is brought in with an acute onset of epigastric pain, nausea and severe vomiting. The pain is worse with movement and is only relieved slightly by leaning forward. The patient is an alcoholic and has been admitted to the emergency department on several occasions for alcohol intoxication. On examination the patient is tachycardic, pyrexial and dehydrated. The abdomen is diffusely tender and soft, and bowel sounds are normal. The patient's serum amylase is raised by six times the upper limit of normal. The most likely diagnosis is?
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 worried 23-year-old woman, who started taking the combined contraceptive pill 3 months ago, presents with a 1-day history of discovering a painless lump in the right breast. The patient states that the lump was not there a month ago. On examination, a slightly mobile, discrete, well-defined, non-tender, firm 1 cm diameter lu1np is found. There is no lymphadenopathy. The most likely diagnosis here is?
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?
A 24-year-old sexually active medical student is diagnosed as having a urinary tract infection by her GP. Which one of the following organisms is most commonly associated with community acquired urinary tract infection?
An 18-year-old school student of East African origin presents with a 2-week history of lethargy, myalgia, rigours with hot flushes and intermittent pyrexia. Neither she nor any close contacts have been travelling recently. Examinati.on reveals enlarged anterior and posterior chain lymph nodes in the neck. A blood ftlm reveals the presence of Downey bodies, thrombocytosis and an increase in the lymphocyte count to SO% of total leucocytes. This girl is likely to have?
A 46-year-old woman has a PIPJ flexion and a DIPJ hyperextension deformity of the left ring finger. What is the most likely diagnosis?
A 55-year-old Caucasian woman is referred to the clinic by her dentist. She noticed a painless white spot on her tongue a few months ago, which has failed to heal with topical therapy and is still present 3 weeks later. She smokes 30 cigarettes per day and drinks approximately 30 units of alcohol per week. On examination, she has a small ulcer on the tip of her tongue. Tongue movements are not affected. There is no palpable cervical lymphadenopathy. Which one of the following is the best statement regarding management/ diagnosis?