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3,531 questions
A 40-year-old woman is being evaluated for fever. She started having fever 6 weeks ago. Other symptoms include an erythematous rash, fatigue, and weight loss. Her medical history is significant for hypertension. She takes hydrochlorothiazide. On physical examination, the patient's temperature is found to be 100.6° F (38.1° C), a 3/6 murmur is noted in the mitral area, and an erythematous rash is seen on both legs. A complete blood count shows anemia; the patient's erythrocyte sedimentation rate (ESR) is elevated at 80 mm/hr. A transthoracic echocardiogram shows a 2 cm pedunculated mass in the left atrium. Which of the following is the most likely diagnosis for this patient?
A 67-year-old man with type 2 diabetes and a long history of cigarette smoking develops severe exertional chest pain. Cardiac catheterization reveals three-vessel disease. Twenty-four hours later, he develops abdominal pain, painful toes, and a rash. On examination, he has purple discoloration of the second and fourth toes on his right foot and a lacy rash on both legs. Laboratory results are as follows: Hb, 13; HCT, 39; WBC, 9.0; BUN, 26; and Cr, 1.8. What is the most likely diagnosis for this patient?
A 76-year-old woman presents to the emergency department for evaluation of nausea and mild epigastric pain that started suddenly 45 minutes ago. She denies having chest pain. Her medical history includes diabetes mellitus, hypertension, and hyperlipidemia. An electrocardiogram is interpreted as being normal. For this patient, which of the following statements regarding the diagnosis of unstable angina is false?
A 59-year-old man presents to his GP with sudden onset severe pain, tenderness and swelling of the first metatarsophalangeal joint. He is known to suffer from acute gout and has had several previous similar episodes. What is the most appropriate treatment?
A 67-year-old man presents for evaluation of worsening dyspnea. The patient reports that his symptoms have been worsening over the past several months. He also mentions that he has developed some swelling in his legs and notes that he is easily fatigued. His medical history is remarkable for type 2 (non-insulin-dependent) diabetes mellitus, presumed cytogenic cirrhosis, and ''arthritis'' in his hands. The patient denies ever using alcohol. On physical examination, the patient's vital signs are normal; examination of the jugular venous pulse shows the height to be 10 cm; no thyromegaly is present; pulmonary examination reveals faint basilar crackles; cardiac examination shows nondisplaced point of maximal impulse and no audible murmur; no hepatosplenomegaly is noted; and 2+ bilateral lower extremity edema is noted. An ECG is unremarkable. An echocardiogram reveals normal ejection fraction and normal valvular function. You order lab work that includes iron studies and make the diagnosis of hemochromatosis. What is the pathogenesis of heart failure in this patient?
A 42-year-old woman attends to her GP complaining of non-specific abdominal pain and an increasing abdominal girth. She is found to have a large mass in her right lower abdomen and ascites on transvaginal ultrasound imaging. Which of the following tumour markers would be most useful?
A 34-year-old woman with systemic lupus erythematosus (SLE) has had multiple miscarriages and now presents with a painful right swollen leg. A compression ultrasound scan confirms deep vein thrombosis. Which blood test may now be indicated?
A 63-year-old man is admitted to the emergency department with severe dyspnoea. He is a longstanding smoker of 40 years. His observations are pulse rate 130 bpm, respiratory rate 36/min, oxygen saturation of 85o/o on 24% oxygen via a venturi mask and temperature 38.2°C. Chest examination reveals reduced air entry on both lungs with coarse crackles on his left lower lobe. Despite immediate maximum standard medical treatment on controlled oxygen therapy, his arterial blood gas still shows persistent acidosis with a PaC02 of 8 k.Pa. Which of the following would NOT be a required inclusion criterion for non-invasive ventilation?
A 52-year-old man with a history of alcohol excess presents to his GP because he cannot fully extend his ring finger on his right hand (neither actively nor passively). Since the imger is permanently partially flexed he can no longer place his hand flat on a flat surface. Which of the following is the most likely diagnosis?
90% A 34-year-old woman, who is known to be human immunodeficiency virus (HIV) positive, presents with multiple lesions on her face. The lesions are raised and shiny, non-tender and around 3 mm in diameter. They have an umbilicated centre. What is the most likely diagnosis?
A 23-year-old man presents to the rheumatology clinic with lower back and hip pain. These have been occurring every day for the past two months. Pain and stiffness are worse in the mornings. He also mentions that his right heel bas been hurting. He is previously fit and well, but had occasions of lower back pain when he was a teenager. His symptoms have stopped him from playing tennis. Recent blood tests organized by his GP have shown a raised C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). What is the most appropriate treatment?
A 45-year-old man was diagnosed with new onset AF after visiting his GP complaining of palpitations. An ECG confirmed atrial fibrillation with a ventricular rate of 85/minute, and an ECHO did not reveal any significant structural heart disease. On advice of the hospital he was given low molecular weight heparin and stabilised on warfarin, with an INR of 2.5. Yon arrange for him to be cardioverted a few weeks later and the procedure is successful. For how long is it recommended to continue his warfarin therapy according to current guidelines?
A 78-year-old woman presents with palpitations that began an hour ago. She feels clammy to the touch. Whilst she is clutching your hand and telling you her past medical l1istory, you check her observations on the bedside monitor. You notice that her heart rate is 230 bpm and regular. The QRS complexes are narrow and no P-waves are noted. What is the most likely arrhythmia?
A 54-year-old woman presents to her GP complaining of repeated incidents of burning central chest pain. It mainly occurs when she lies down to go to bed at night. She is overweight with a body mass index of 40. She uses glyceryl trinitrate (GTN) occasionally but it doesn't always relieve her symptoms. She doesn't report any shortness of breath or palpitations and examination is unremarkable. What is the most likely diagnosis?
A 65-year-old woman presents to hospital with left-sided weakness of sudden onset. She is a type II diabetic, smokes 20 cigarettes/day and has high blood pressure. On examination, power in the left arm is O throughout although the left leg shows a power of 3 at the hip and knee and 4 at the foot. Her reflexes are reduced throughout, and sensation is absent in the arm and reduced in the leg. In the cranial nerve examination she is unable to see on her left-hand side, and the lower half of her left face is weak (she can raise her eyebrow). Tl1ere is no dysphasia. Which vascular territory is affected?
A 40-year-old woman presents to the rheumatology outpatient clinic with a three- month history of stiff hands and wrists. She mentions that the pain is particularly bad first thing in the morning. On examination, the wrists, metacarpophalangeal joints and proximal interphalangeal joints are swollen and warm. A diagnosis of rheumatoid arthritis is suspected. Blood tests for rheumatoid factor return as positive. What is the most appropriate management?
A 33-year-old woman with multiple sclerosis (MS) is having problems with painful spasms and disabling spasticity in her left leg. Which of the following medications is most likely to help?
A 27-year-old woman who works in the city as an investment banker presents with difficulty walking, and a tremor in the right hand. It has come on over the last 4 days and she is now unable to get to work safely. She denies any preceding respiratory or gastrointestinal infection or any abnormal stress at work or in her personal life; however, she says that 5 months ago she had some pain and blurring in the left eye for about 10 days, but she put that down to ''sinusitis'', kept working, and things returned to normal. Her grandfather, who died 2 years ago, bad Parkinson's disease for some time, and she is concerned that this could be the same thing. On examination, in her arms, there is normal tone, power and sensation, but there is indeed a tremor in the right hand on testing coordination, which gets worse on approaching the target, and is absent at rest. In the legs, there is normal power, but decreased light touch sensation bilaterally and a loss of vibration sense and proprioception up to the ankles. What are you most concerned is the diagnosis?
A 56-year-old man who has been recently diagnosed with sigmoid cancer and had a Hartmann 's procedure is admitted to hospital with acute-onset shortness of breath. He denies any collapse or fainting. He has a past medical history of chronic obstructive pulmonary disease, hypertension, stroke and gout. His observations include temperature 37.2°C, pulse rate 106 bpm, blood pressure 110/74 mmHg, respiratory rate 25/min and saturations 87% on room air. There is no significant finding on chest examination. An electrocardiogram (ECG) shows sinus tachyc.ardia with no ST elevation. A plain chest X-ray shows a small left pleural effusion. Which of the following is the most appropriate diagnostic investigation?
A 32-year-old woman who is known to be 17 weeks' pregnant presents for review. She has periods of paroxysmal supraventricular tachycardia (SVT) and on this occasion has a ventricular rate of 165/min and a blood pressure of 90/50 mmHg, feeling faint and unwell. Which of the foilowing anti-arrhythmics would be the most appropriate prophylaxis for her?