Medical
Browse, search and filter 3,531 questions.
3,531 questions
A 35-year-old woman has had a diffuse mild arthralgia with a fluctuating time course for the last year. There is never much synovitis to be seen on examination and inflammatory markers are only mildly raised. ANA is positive. Which of the following would make a diagnosis of systemic lupus erythematosus (SLE)?
A 23-year-old final year law student presents to the GP with a cough productive of foul green sputum. He also complains of breathlessness on exertion. He has had an average of five respiratory tract infections per year for the past 2 years. As a child, he could not tolerate dairy products. On examination, finger clubbing is present and there is dullness to percussion of the right upper lung zone with widespread bilateral wheeze. What is the most probable diagnosis?
A 25-year-old primigravida who is 26 weeks' pregnant, presents to the casualty department with symptoms of headache, flashing lights and vomiting. Her blood pressure was recorded at 140/100 mmHg and her antenatal diary showed consistent systolic readings of 110-120 mmHg and consistent diastolic readings of less than 80 mmHg. She has a history of mild asthma but was otherwise in good health prior to pregnancy, and there is no family history of note. Which of the following would be the drug of first choice?
A 74-year-old woman patient, who is being treated for chest infection following an elective gastrectomy, develops profuse diarrhoea. A stool sample is collected and microscopy, culture and sensitivity reveal Clostridium difficile toxin. What is the most appropriate treatment?
A 67-year-old man presents with painless rectal bleeding for the past 2 months. It occurs mainly on defecation, and is bright red in the pan and on the toilet paper. A digital rectal examination is unremarkable. What should your management be?
A 19-year-old female presents to the emergency department with a severe headache, photophobia, neck stiffness and a temperature. She is treated for bacterial meningitis with intravenous ceftriaxone. Blood cultures grow Neisseria meningitides. The next day, she starts bleeding from around her intravenous cannula and venepuncture sites. Which of the following investigation results would you NOT expect in disseminated intravascular coagulation?
An 81-year-old woman is referred to cardiology out-patients with a history of dizzy episodes and one episode of syncope. She is known to have long-standing atrial fibrillation. A 24-hour tape confirms atrial fibrillation, with rates varying from 30 to 140 bpm. There are several daytime pauses of over 3 seconds. She is listed for a permanent pacemaker. Which of the following would be the most appropriate device?
A 59-year-old woman with advanced metastatic breast cancer presents to the emergency department with severe abdominal pain. She has not opened her bowels for 7 days and feels constipated. She has also noticed that she has been passing water more frequently but has not been incontinent. On rectal examination there is no loss of anal tone and normal sensation. What is the most likely diagnosis?
You are called in the middle of the night to see a 49-year-old man with known alcoholic liver disease admitted 2 days previously. He is shaking, sweating, tachycardic, apyrexial and believes he is seeing spiders crawling across the ceiling. What is the most likely diagnosis?
A 27-year-old woman presents to the GP complaining of intense sharp pain on passing stools, accompanied by bright red bleeding noticed on the toilet paper. She has no fever and is otherwise well in herself. She recently had a course of codeine phosphate following a sprain injury to her ankle. What is the most likely diagnosis?
A 72-year-old woman is admitted for assessment after two episodes of collapse over the past few months. She has been managed by her GP for many years for hypertension and is currently treated with indapamide and amlodipine. On examination she looks a little thin. Her BP is 175/125 mmHg. Auscultation of the chest reveals an ejection systolic murmur. She has minor crackles at both Jung bases. Investigations; Hb 13.0 g/dl, WCC 5.3 x109/I, PLT 194 x109/l, Na+ 140 mmol/1, K+ 4.2 mmol/1, Creatinine 145 µmol/1. Cardiac catheterisation gradient of 50mmHg across the valve. Which of the following would most influence your decision to refer this patient for valve replacement?
A 35-year-old man presents with a 3-week history of pain and swelling in the tips of his fingers. He has no history of bowel problems, recent infection or skin disease, but his brother has Crohn's disease. On examination you find several swollen, red, tender distal interphalangeal USMLE IM2e/Diagnostic joints, and the nails have separated from the nailbed and have small pockmarks covering them. The rest of the examination is unremarkable. Which of the following diagnoses is most likely?
A 73-year-old woman is admitted for pacemaker insertion because of a number of syncopes and periods of complete heart block identified on 72hr ECG. She receives a DDDR pacemaker. What does the R stand for?
A 53-year-old man, who has had some lower back pain and sciatica into his right leg for the past year, presents with a 2-day history of leg weakness and severe pain. On examination, which of the following signs does NOT make you think of cauda equina syndrome?
You are asked by your registrar to see a 40-year-old woman and report back your findings. On examination, you struggle to find an apex beat although heart sounds 1 and 2 were audible with no murmur. On inspection, her electrocardiogram (ECG) is normal except for inverted P-waves. What is the most likely reason for these findings?
A 37-year-old woman is being investigated for weight loss and diarrhoea. Barium enema shows ''cobble-stoning'', rose thorn ulcers and colonic strictures at intermittent points throughout the colon. What is the most likely diagnosis?
A 60-year-old man with NYHA (New York Heart Association) class II heart failure, is taking angiotensin-converting enzyme (ACE) inhibitors and 8-blockers for his heart failure. He is generally well in himself. On direct questioning at his routine outpatient visit, it is noticed that his exercise tolerance has decreased over the last year. Which of the following drugs should be added to his list of medications?
A 61-year-old woman presents to the walk-in clinic with a history of tight, sternal chest pain ''appearing out of the blue''. Such episodes have occurred at different times throughout the day and rarely last longer than a few minutes. They do not correspond to hard exercise. The patient has no cardiac history to date. Her electrocardiogram (ECG) has not detected any abnormalities and 2 days have passed since the last episode. Which of the following is the next best step in her management?
A 30-year-old woman aid worker, who has returned from a trip to Haiti 1 day ago, presents to accident and emergency with profuse watery diarrhoea. This started suddenly and she describes her stool as being profuse and colourless. On examination her pulse is 120 bpm. What is the most appropriate treatment?
pH 7.51, p02 18, pC02 2.3, HC03-24 A 65-year-old man presents to the GP with chest pain, increasing shortness of breath and weight loss. He describes the pain as dull and worse on inhalation. He notices that he has lost 1 stone in 3 weeks. He has never smoked and has no other significant past medical history. He used to work in a shipyard. Observations include temperature 36.8°C, pulse rate 80 bpm, blood pressure 140/95 mmHg and respiratory rate 18/min. On examination, there is dullness to percussion over the left lower lung zone. What is the most likely diagnosis?