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3,531 questions
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 33-year-old, non-smoking, breastfeeding woman is 10 days postpartum. She has a 4-day history of a slight crack on the surface of her left nipple. She presents with a 2-day history of severe continuous pain in the left breast, spiking pyrexia up to 38.8 with rigours which has prevented her from sleeping. On examination, you find the outer quadrants of the left breast to be red, warm and tender with a hard 3 cm lump at the edge of the left nipple. The most likely diagnosis is?
A 35-year-old woman is due for a bilateral mastectomy. She has requested a bilateral breast reconstruction at the same time. However, she is a strict Jehovah's Witness and would under no circumstances have a heterologous blood transfusion. The diagnostic of this patient is?
: Le tissu conjonctif présent au niveau de la paroi des grosses artères n’a aucune propriété mécanique.
A 65-year-old nulliparous woman presents to your clinic with a I11mp in her left breast, which was discovered 7 months ago. On examination you find a hard, ill-defmed, non-tender, 3.5 cm lump behind the left nipple. The patient has also had bloody, non-purulent discharge from a single duct on the left nipple for over 3 months. The most likely diagnosis here is?
A 43-year-old woman presents to your clinic with a 2-month history of localized dull pain in the right breast. The pain intensifies just before her period. On examination, you find a discrete 2.5 cm mobile, tense, tender, fluctuant lump in the lower inner quadrant of the right breast. The most likely diagnosis here is?
A 29-year-old nurse is referred to the neurology outpatient clinic with a 6-month history of intermittent upper limb jerking, in which a digit on the left hand jerks initially, extending to the USMLE Surgery2e/Diagnostic hand, arm and eventually the face. She reports being aware of these movements and feeling weak in the same arm for several hours after. This type of seizure could be described as being?
A 21-year-old nulliparous woman presents to your clinic with a 1-month history of bilateral breast pain. The pain, which is dull and achy in nature, is poorly localized and widespread across both breasts. The pain gradually increases in severity and is worse just before her menses. The pain usually starts to get better once her menses start. On examination, both breasts are tender. There are no lumps, skin changes or obvious swellings. The most likely diagnosis here 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 28-year-old secretary presents with a lump in the midline of the neck that has grown progressively larger over the past several months. On examination, there is a palpable lymph node in the left submandibular region. An aspirate is taken, comrrming a malignant cancer of the thyroid gland. The origin of this is most likely to be?
A patient is admitted following a car accident where she was a restrained passenger. The patient is 32 weeks pregnant. She is shocked with a rigid and tender abdomen. An abdominal radiograph is performed which shows air under the diaphragm and the fetus's left leg appears extended. The most appropriate next course of action is?
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 20-year-old footballer is involved in a heavy tackle where another player impacts with outside of his knee. He feels pain over the inner aspect of his knee, and he has a positive valgus stress test but with a firm end point. What is the most likely diagnosis?
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 previously well 35-year-old woman presents with sudden onset severe headache and loss of vision. Her acuity is 6/24 bilaterally on assessment in the emergency department. What is the most likely diagnosis of this patient?
A 75-year-old man presents to the surgical unit with a 24-hour history of acuteonset left loin pain, which seems to worsen intermittently and has not settled with regular simple analgesia. He suffers from mild dementia and is unable to recall the details of his past medical history. The foundation year 2 doctor on call suspects that a urinary calculus is the cause of this man's pain USMLE Surgery2e/Diagnostic and spots an old pathology report in the patient's notes showing the presence of negatively birefringent crystals in a synovial fluid aspirate. Which one of the following substances is likely to make up the majority of this man.'s calculus?
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?
A 40-year-old female lawyer is referred to the urology outpatient clinic with a history of multiple urinary tract infections over the preceding 10 years, which have required increasingly longer courses of antibiotics to treat. She also reports feeling more lethargic of late, despite leading a relatively active lifestyle. An ultrasound scan of this patient's renal tract indicates chronic pyelonephritis. Which of the following sonographlc features would be diagnostic of her condition?
Your registrar tells you that his patient has a boxer's fracture. From this, you know that the bone which is fractured is?
A 14-month-old girl is brought to the emergency department with a 12-hour history of fever and rash. Her mother became frightened when it was difficult to arouse the girl after her nap. Findings on physical examination include a temperature of 104°F (40°C), a heart rate of 164 beats/min, a respiratory rate of 42 breaths/min, and a blood pressure of 75/45 mm Hg. There are petechiae and purpura (Item Q156A) on the chest, arms, and legs. As you are establishing intravenous access and drawing blood for initial laboratory evaluations, you request an immediate dose of antibiotics. Of the following, the MOST appropriate therapy is