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3,531 questions
A 68-year-old man is diagnosed with right forearm cellulitis. Yon are asked to start the patient on treatment and he has no known drug allergies. Which one of the following antibiotics would be the most appropriate choice in this scenario?
A 30-year-old postman with hypertension but normally i.n good health presents to the emergency department with sudden severe breathlessness and sweating. Chest examination reveals bilateral basal crackles. He improves with diamorphine and frusemide (furosemide). Electrocardiograms (ECGs) and cardiac enzymes are normal. He develops two further episodes of pulmonary oedema which respond well to diuretics. The most likely cause of pulmonary oedema is?
A 70-year-old man presents to establish care. His medical history is remarkable for hypertension and a myocardial infarction 3 years ago. His medications include aspirin, 325 mg daily; metoprolol, 100 mg twice daily; and isosorbide mononitrate, 120 mg daily. He reports that when walking more than one block he has substernal chest pressure, which is relieved by rest. He had a cardiac catheterization 2 months ago that showed a left main coronary artery stenosis of 80%, a proximal left anterior descending artery stenosis of 60%, and a 70 o/o stenosis of the first obtuse marginal branch. The left ventricular ejection fracti.on (L VEF) was estimated at 45o/o. Which of the foilowing therapies would be most beneficial for this patient?
A 40-year-old man comes to your office as a new patient to establish primary care. He is asymptomatic. His physical examination reveals an early systolic click and a 2/6 murmur in the aortic area. An ECG is normal. An echocardiogram shows a bicuspid aortic valve without significant flow obstruction. His ventricle size and function are normal. Which of the following is the most appropriate therapeutic intervention for this patient at this time?
Cardiac catheterisation is performed on a 25-year-old man with a systolic murmur but no symptoms. ECG and chest X-ray are normal. The findings are as follows (pressures mmHg): aorta, 125/70; left ventricle, 120/12; right atrium, mean 8; right ventricle, 40/8; pulmonary artery, 44/14; pulmonary capillary wedge, mean 13. Saturations(%): aorta, 97; superior vena cava, 68; right atrium, 70; right ventricle, 82; pulmonary artery, 85. What is the most likely cardiac diagnosis?
A 25-year-old man presents to the emergency department wth a 1-week history of fever and myalgia. He had travelled to Chile 8 weeks ago. On examination there are no positive findings, although the patient recollects that his right eyelid was swollen for a few weeks after be left Chile. ECG reveals non-specific, T-wave changes i.n all leads. What is the most likely diagnosis?
A 56-year-old man, diagnosed with psoriasis three years ago, presents to your clinic with pruritus. His symptoms are not improving despite being prescribed conventional therapy. On examination, you note the presence of erythematous scaly plaques on the extensor surfaces of the knee and elbows. There is no evidence of flexural involvement. The most appropriate treatment 1• s:
A 25-year-old medical student noticed that he had a murmur when he tested his new stethoscope. On assessment in the cardiology clinic, he was fo11nd to have a harsh systolic murmur over his precordium, which did not change with inspiration. ECG showed features of bi.ventricular hypertrophy. What is the most likely diagnosis?
To establish the aetiology of pulmonary hypertension, a cardiac catheter study was performed. The wedge pressure was normal and the mean mitral valve diastolic pressure gradient was > 3 mmHg at rest, both of which increased with exercise. Fro1n this data, what is the probable diagnosis?
An 18-year-old man presents to you with an itchy scalp which has been present for 2 weeks following a visit at the barber shop. On examination, you notice a 3 x 3 cm oval area of patchy hair loss in the crown area of the scalp with a ring of erythema. You suspect that the patient has a dermatophytic infection. Which one of the following options would be the most appropriate in treating this condition?
A 60-year-old man with unstable angina on long-term digoxin was being monitored on the ward with telemetry when the monitor displayed a tachycardia of 180 bpm. The printout showed discrete normal morphology P waves before each QRS complex and there was an acceleration in the rate after initiation of the arrhythmia. The QRS width was 0.12 s. Which of the following is the most likely arrhythmia?
A 55-year-old woman with metastatic pancreatic cancer attends the oncology clinic prior to her second cycle of chemotherapy. She tolerated her first cycle well, but her husband mentions that there have been occasions where she has been confused. Her urea and electrolytes on this occasion reveal a ser11m sodium of 116 mmol/L. All other results were within the normal range. The chemotherapy is delayed and a urine specimen is sent off. This confirms a diagnosis of syndrome of inappropriate ADH (SIADH). The most appropriate treatment is:
A 25-year-old man was found by his family at home havin.g suffered a cardiac arrest. He was previously well, apart from well controlled Type 1 diabetes controlled with a basal bolus insulin regime. His family followed the ambulance and ask if they can be in the resuscitation room. After 20 mins of repeated resuscitation cycles he has remained in asystole. Blood gases; pH= 7.01, P02= 8.4 kPa, PC02= 3.9 kPa, Bicarb= 10 mmol/1. Which person is the most appropriate person to make the decision to discontinue resuscitation?
A patient has broad-complex tachycardia features resembling ventricular tachycardia rather than supraventricular tachycardia with a bundle-branch conduction defect. Which of the following makes Wolff-Parkinson-White the most likely underlying diagnosis?
A 68-year-old woman recently diagnosed with multiple myeloma presents to her GP with progressively increasing breathlessness, exercise intolerance and ankle swelling. On examination, there is bilateral pitting leg oedema to her thighs, ascites and raised JVP. The apical impulse is impalpable. An ECG shows diffusely diminished voltage. Chest X-ray is normal and the echocardiogram shows small thick ventricles and dilated atria with a thickened interatrial septum. The ventricular myocardium has a granular sparkling texture on echo, and minimal fluid in the pericardia] space is noted. What is the most likely diagnosis?
A 40-year-old woman presents to the GP with a history of weight loss and irritability. She has lost 1 stone in the past 2 weeks. She claims that she has a normal appetite. She also complains of blurring of the vision for the past month. On examination, she has a ''staring look'' with lid lag and lid retraction. What is the most likely diagnosis?
A SO-year-old woman with T2N2Ml squamous cell carcinoma of the tongue has been electively admitted for her third cycle of palliative cisplatin/5-fluorouracil chemotherapy. She has known metastasis to the T3 vertebrae and the ribs. Since her last cycle of chemotherapy she has been very lethargic and constipated. Upon checking her bloods you discover that her corrected calcium levels are 2.95 mmol/L. The most appropriate treatment is:
A 70-year-old woman presents with hip pain following a fall. The fall appears to have been related to alcohol ingestion and, whilst the history is vague, she denies loss of consciousness and does not seem grossly confused, nor is there evidence of infection. She is a smoker and has a history of ischaemic heart disease and depression. A hip fracture is ruled out and she is admitted for rehabilitation purposes. On day 3, however, the nurses report that she is increasingly sleepy and muddled. On examination, observations are stable, she is apyrexial, her Glasgow Coma Score (GCS) is 12, and on neurological examination, she appears to have some mild left arm and leg weakness with normal or brisk reflexes. There is no hemianopia or other neurological deficit. Which of the foilowing is most likely to explain the changes?
A 43-year-old woman presents with an acute sharp, central chest pain radiating to the left arm that is worse on inspiration and at night. She reports that it is preventing her coughing which, in turn, is prolonging a recent chest infection. On examination, her chest exhibits vesicular breath sounds with bi-basal crackles. Her electrocardiogram (ECG) shows widespread concave ST elevation in sinus rhythm. Which of the following is the most likely diagnosis?
A 42-year-old woman with known HIV presents with a 3-week history of dry cough and increasing breathlessness. She is now unable to walk 100 yards without becoming short of breath. You suspect pneumocystis pneumonia. Which of the following tests is the best way to confirm the diagnosis?