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3,531 questions
A 56-year old man has a myocardial infarction the day after a hernia repair. You request an ECG and then compare it to his pre-admission trace. You notice ST-segment changes in leads II, ID and aVF. In which part of the myocardium is the infarct?
A 78-year-old retired groundskeeper presents with a 2 cm skin lump on his temple. He is unsure how long it has been there. It appears to have a rolled, shiny edge with telangiectasia and a central ulcerated area. Which of the following is the most likely diagnosis?
A 55-year-old Asian man with known thalassaemia trait registers with a new GP and is found to have a mild microcytic anaemia on routine testing. He does not complain of any symptoms. What is the most appropriate treatment?
A 60-year-old woman presents to her GP with a chronic cough associated with thick, yellow sputum for the past year. Sometimes, the sputum is blood-tinged. She had been prescribed multiple courses of antibiotics but they did not seem to help. She had a past medical history of severe pneumonia that required admission to the intensive care unit for 20 days. On chest examination, there are inspiratory crackles throughout the lung fields, with normal vesicular breath sounds. Which of the following is the most likely differential diagnosis?
A 32-year-old woman presents to her GP complaining of tingling and numbness around her mouth for 1 week. Occasionally, she also develops painful carpal spasm. She has a past medical history of Graves disease for which she just recently had subtotal thyroidectomy. What is the most likely diagnosis?
A 55-year-old woman presents with mild cognitive impairment and disinhibition without significant mood change. She also has falls and urinary incontinence. She has no major past medical history or medications, and has never smoked or drank much alcohol. On examination, there are no cranial nerve or arm defects, however the legs appear to have increased tone, upgoing plantars and clonus bilaterally with some weakness of hip and knee flexion bilaterally. Which of the following diagnoses may explain the picture?
A 59-year-old man is admitted to the emergency department following a fall. He complains of increased tiredness and jerking movement of his legs, which led to his fall from the staircase. He is a smoker. On arrival, he has an oxygen saturation level of 76% in air, and an arterial blood gas reading-demonstrates: pH 7.40, Pa02 6 kPa, PaC02 9.3 kPa, HC03 35 mmol/L on room air. His respiratory rate was 20/min. What does this blood gas result show?
You are examining a tearful young child who has fractured her arm. On auscultation you hear an ejection systolic murmur. There is no cyanosis. Which of the following prevents you reassuring her calm dad that his daughter has no serious heart problem?
A 43-year-old man presents with intermittent haematuria. On examination of the abdomen, bilateral masses are felt and an ultrasound reveals polycystic kidneys. You explain the syndrome to him. He is concerned that his son may develop the disease. He does not believe his wife suffers from the condition. What is the probability that his son will develop the disease?
A 79-year-old woman who was admitted to hospital with a fractured right neck of femur 1 wee.k ago suddenly becomes acutely unwell on the ward 6 days after her operation. She complains of sudden-onset of shortness of breath and chest tightness. The pain is exacerbated by deep breathing. She has a past medical history of hypertension, hypercholesterolaemia and asthma. Her observations include temperature 37.8°C, pulse rate 108 bpm, blood pressure 96/66 mmHg, respiratory rate 26/min and saturations 89o/o on room air. On examination, her chest is clear to both auscultation and percussion. An electrocardiogram (ECG) shows sinus tachycardia without bundle branch block. What is the most likely diagnosis?
Your clinic patient has been diagnosed with pulmonary tuberculosis (TB) following a three-month history of haemoptysis and fever. The patient is due to start on treatment and you are asked by your registrar which of the following regimes is the most suitable. The patient has no known drug allergies and, in addition, liver function tests and urea and electrolytes results are all within normal ranges. From the list below, which of the foilowing answers is the most appropriate and recommended treatment regimen for this patient?
An SO-year-old man attends the general practice for an annual check-up of his hypertension. He gingerly tells you all about his ''left ventricular hyperthingummy''. You check him and his records for confirmatory signs and symptoms. Which of the following is NOT a sign of left ventricular hypertrophy?
A 64-year-old man presents to the emergency department with a large rectal bleed and left-sided abdominal pain. He has a long history of constipation. He has a temperature of 38.4°C and a heart rate of 110 bpm. What is the most likely cause?
A 34-year-old woman presents to the GP complaining of a new rash. The skin under her arms and on the back of her neck is dark and velvety in texture. She has a past medical history of diabetes for which she takes insulin. What is the most likely diagnosis?
A 70-year-old woman who has been in hospital for 5 days with severe pneumonia and treated successfully with intravenous co-amoxiclav and oral clarithromycin develops profuse watery diarrhoea. Her pulse rises to 110 bpm and she develops a temperature of 38.3°C. She is also taking omeprazole for reflux disease. Stool samples are positive for Clostridium difficile toxin. Which one of the following is the best treatment plan?
You find an 80-year-old man collapsed in the street. He is unresponsive and is making a snoring sound. An ambulance has been called but has yet to arrive. Which of the following is the best course of action?
A 4-year-old boy swallowed a button battery while playing with his older siblings. He and his mother present to you, the GP, after a few hours. He is otherwise well in himself and has no previous medical history. What should you do?
A 55-year-old man, who has never smoked and with no past medical history, has been diagnosed with right basal community-acquired pneumonia. There are minimal changes on his chest x-ray and bloods reveal a neutrophil count of 8.2 and a C-reactive protein (CRP) of 15. He has no drug allergies. Although he has a productive cough of green sputum, his respiratory rate is 16, oxygen saturations are 97 per cent on room air and his temperature is 37.4°C. You are asked to place him on treatment. Which of the following treatment options would be appropriate for this patient?
A 54-year-old male with type 2 diabetes mellitus reports 3 months of exertional chest pain. His physical examination is notable for obesity with a body mass index (BMI) of 32 kg/m2, blood pressure of 150/90, an S4, no cardiac murmurs, and no peripheral edema. Fasting glucose is 130 mg/dL, and serum triglycerides are 200 mg/dL. Which of the following is most likely in this patient?
You see a 76-year-old woman in accident and emergency who bas been admitted with a 1-day history of shortness of breath and pyrexia (38.4°C). The patient's past medical history includes hypertension, stroke and insulin-dependent diabetes. She has no known drug allergies. The nursing staff report that the patient vomited after her lunchtime meal yesterday. On examination the patient's respiratory rate is 26, oxygen saturations 93 per cent on room air. On auscultation of the chest, you hear right basal crackles. You suspect that this patient is suffering from aspiration pneumonia. From the list below, which is the most appropriate antibiotic regimen for this patient?