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3,531 questions
A 72-year-old man is bed-bound following a severe stroke several years previously and lives in a nursing home with full-time care. The staff noticed that over the last 8 days he didn't pass any stool motions until this morning, when there was profuse, offensive liquid stool. They are concerned this may be infective diarrhoea. On examination there is hard stool in the rectum. What is the most likely diagnosis?
A 63-year-old male smoker, on diuretics for essential hypertension, presents to the emergency department with chest pain. His ECG is presented to you. Amongst other signs, you notice T-wave inversion. Which of the following does not cause T-wave inversion?
A 74-year-old man is admitted to hospital with an acute-on-chronically ischaemic leg and started on intravenous heparin. Blood tests taken 5 days later show platelet levels have dropped from 250 to 54 x 109. What is the most likely cause for thrombocytopenia in this patient?
A 60-year-old Chinese man presents to the GP with a 4-month history of weight loss. He has lost around 1 stone in weight. He also has a cough productive of green sputum without blood. He has a reduced appetite, insomnia and night sweats. His past medical history includes hypertension and ischaemic heart disease. He is a retired 1nanaging director who has just emigrated from Hong Kong to England. He denies a smoking history. His observations include temperature 36.4°C, pulse 67 bpm, blood pressure 152/92 mmHg and respiratory rate 15/min. On examination, there is dullness to percussion over the left upper lung zone. 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 40-year-old man comes to clinic complaining of skin lesions. His symptoms started 6 weeks ago, with crusted lesions localized on his face, back, and chest; he denies having any oral lesions. He has no medical history and is not taking any medications. On physical examination, the patient has several crusted lesions on his face, upper chest, and back. Results of a skin biopsy are consistent with pemphigus foliaceus. Of the following, which is the most appropriate treatment for this patient?
A 32-year-old woman presents to the GP with a 3-month history of non- productive cough and breathlessness on exertion. She also complains of fatigue, weight loss and joint pain. She smokes 15 cigarettes/day. She bas not travelled to any foreign countries recently. On examination, fine interstitial crackles are heard on the anterior chest wall. There are m.ultiple tender red lumps on both shins. What is the most likely diagnosis?
A 62-year-old woman presents to the emergency department with collapse. She felt dizzy when she tried to stand up from a sitting position. She did not lose consciousness. Sl1e denied any visual disturbances, headache or head injury. She also complained of fatigue over the past month. She takes only omeprazole and paracetamol. An electrocardiogram (ECG) showed normal sinus rhythm. Her blood pressure was 102/50 mmHg. A blood test revealed the following: Na+ 126 mmol/L, K+ 6.5 mmol/L, urea 10.0 mmol/L, and creatinine 139 µmol/L. What is the most likely diagnosis?
A 6-year-old boy bas a 1-month history of aching bones and muscle pains. On examination he appears pale and has multiple bruises along his legs. He has extensive lymphadenopathy. Blast cells are seen on the blood film. What is the most likely diagnosis?
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 75-year-old man has been recently diagnosed with Parkinson's disease and started on levodopa (L-DOPA), which has helped his tremor and bradyk:inesia significantly. However, in the past week be had a fall shortly after getting out of his chair, during which he briefly blacked out, and afterwards was sweating and felt cold. Which of the following side effects most likely explains the fall?
A 7-year-old boy presents with multiple erythematous patches, over both sides of his face, head, neck, upper chest and left arm and shoulder, which appear to be covered in a honey-coloured crust. His mother says that the lesions have spread, over about a week, starting at the left neck and radiating outwards. The child appears to be upset and the lesions are itchy. There is no past medical history and no history of recent infections. Which of the following diagnoses is most likely?
A 62-year-old Asian woman presents to the emergency department with increasing shortness of breath for the past 2 weeks. She has a past medical history of breast cancer, ischaemic heart disease, previous myocardial infarction with a stent in her left anterior descending artery, and osteoarthritis. On examination, there are reduced breath sounds on her lung bases, and dullness to percussion. Both legs are swollen. A chest X-ray demonstrates a right-sided pleural effusion. A simple aspiration of the pleural cavity showed a pleural fluid protein:serum protein ratio <0.5. What is the most likely underlying diagnosis?
A 29-year-old woman is concerned about recurrent ulcers she gets in her mouth. Occurring every few months, they are small, grey, shallow ulcers that disappear spontaneously. She has no other gastrointestinal symptoms or weight loss. What is the most likely cause?
A 55-year-old man is referred to haematology with repeated nosebleeds, malaise, weight loss and night sweats. Investigations show a raised white cell count, mainly neutrophils and myelocytes, anaemia, increased urate and increased alkaline phosphatase. On blood film there are no blast cells. Genetic studies show a t(9:22) translocation encoding for the BCR-ABL gene. What is his diagnosis?
A 45-year-old woman with type 1 diabetes and rheumatoid arthritis has been admitted after a massive overdose of ibuprofen and has been noted to have acute renal failure with a creatinine level of around 350 µmol/L. The next day, you are called to see her as she is becoming breathless. Her airway is clear. She looks anxious. Her respiratory rate is 28/min and her saturations are 86o/o on air. You hear bibasal crepitations in her chest, which is slightly dull to percussion at both bases. She has a pulse of 110 bpm and blood pressure of 125/80 mmHg. Her urine output has been 120 ml in the last 10 hours, and you note that her jugular venous pressure is high. It appears from the notes that the night house officer was asked to see her due to her low urine output and prescribed aggressive fluid resuscitation. What is the most likely reason for her breathlessness?
4 USMLE IM2e/Diagnostic A 60-year-old man presents with total visual loss in his left eye that developed over 1 day. He says he had a headache on the left side in the 5 days that preceded the visual loss, which was constant and severe, and worse on talkingoreating. On further questioning he said he has been feeling lethargic for the last 2 months and has been having some shoulder aches. There is no relevant past medical history and he has never smoked. On examination, there is no vision in the left eye, there is a relative afferent papillary defect, and the optic disc appears red and swollen on ophthalmoscopy. There is no other cranial nerve defect or neurological defect. Which investigation would confirm the most likely diagnosis?
A 13-year-old girl, who is quiet and withdrawn, comes to see you with her mother. She has a 4-month history of weight loss and secondary amenorrhoea. She has no bowel symptoms. Her body mass index is 16. Apart from being very thin, the examination is otherwise normal. All blood results, including hormone assays, are normal. What is the most likely diagnosis?
A first-time mother comes to visit you with her 10-month-old son. At least once every day her son vomits up his entire feed. The vomiting is not projectile but rather the feed returns to the mouth and spills over his top. She stopped breast-feeding him when he was 6 months old. He is otherwise well in himself, with a normal weight for his age. What is the most likely diagnosis?
A 43-year-old woman attends the GP with a 3-month history of a grey-white vaginal discharge which she says has a ''fishy'' odour. She is systemically well and has no menstrual abnormalities. What is the most likely diagnosis?