Medical
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3,531 questions
A 72-year-old man who visited his GP suffering from an infection 2 days earlier is admitted to the Emergency room after suffering a collapse at the supermarket. His wife tells you that he suffered from a myocardial infarction some 6 years ago, but has otherwise been relatively well, taking aspirin, ramipril and atorvastatin as regular medications. She doesn't know the type of antibiotics he has been taking. On examination his BP is 120/71 mmHg and he is drowsy. His pulse is 70/min and regular. Investigations; Hb 13.1 g/dl, WCC 5.1 x109/l, PLT 232 x109/l, Na+ 140 mmol/1, K+ 4.2 mmol/1, Creatinine 123 µmol/1, 12 lead ECG sinus rhythm, QT interval O.Ss. Short runs of torsades seen on the monitor. Which of the following is the most likely causative antibiotic?
A 55 year-old man with a history of mitral regurgitation and atrial fibrillation is warfarinised. His INR is therapeutic at 2.0. He needs to undergo pre-planned tooth extraction under local anaesthesia. How would you manage him prior to the procedure?
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 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 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 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?
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 30-year-old man presents to the medical assessment unit with a history of excessive drinking and urination. He has been going to the toilet about 7-8 times per day for 1 month. His random blood glucose is 9.3 mmol. His results on admission show: Na+ 130 mmol/L, K+ 3.5 mmol/L, Urea 2.4 mmol/L, Creatinine 80 µmol/L. Corrected Ca2+ 2.34 mmol/L Plasma osmolality 609 mOsm/kg Urine osmolality 145 mOsm/kg. Water deprivation test- urine osmolality 296 mOsm/kg after DDAVP 2 µg administeredintramuscularly. What is the most likely diagnosis?
A 74-year-old woman presents to hospital with an acute right-sided hemiparesis, and is found to have a left middle cerebral artery infarct on diffusion-weighted magnetic resonance imaging (MRI). It is her first stroke. Her past medical history is unremarkable. Her blood pressure is normal and her electrocardiogram (ECG) shows sinus rhythm with occasional ventricular ectopics. Blood tests show normal cholesterol and normal glucose. On carotid Doppler she is found to have an 85% stenosis of the left carotid. Which of the following treatments will NOT benefit her?
A 24-year-old woman who has been travelling to India on a gap year presents to clinic as she is concerned about a ''funny-looking mole'' on her leg. She is unsure how long it has been there. Which of the following is not a concerning feature of a mole when considering a diagnosis of malignant melanoma?
A 33-year-old man presents to his GP complaining of worsening headaches and tiredness for the last 2 months. He denies drinking alcohol and smokes occasionally. He has a good appetite and has gained 3 pounds over the past month. He also noticed that he has difficulty in biting his food, and has a reduced libido. On examination, he is tall, with an oval-shaped face, large hands and prominent lower jaw. Which of the following tests is the most useful in the initial diagnosis?
An 83-year-old man is admitted with acute confusion. He has an extensive medical history including atrial fibrillation, type 2 diabetes, osteoarthritis, hypertension and some mild congestive cardiac failure, for which he takes several medications. He appears clinically dry, with a pulse of 115/min, dry mucous membranes and a capillary refill rate of 4 seconds. He is noted to have a reduced urine output with concentrated urine. His creatinine is 235 µmol/L. Which of the following medications does not need be reduced or stopped?
A 70-year-old man, admitted two days previously with a mechanical fall and needing rehabilitation, becomes increasingly anxious and agitated on the ward. He has been pestering the nurses for some ''moonshine'', and he is now disorientated in place and time. He claims to have seen little gnomes dashing between patients' beds. You suspect delirium tremens. Which of the following represents best management?
A 45-year-old man is having his second transfusion following blood loss from a road traffic collision. During the transfusion he developed a fever of 38.5°C and rigors. What should your immediate action be?
1 L 0.9% normal saline with 20 mmol potassi11m and 2 x 1 L 5% dextrose with 20 mmol potassiu1n in 24 hours
You are the designated driver on Saturday night and are soberly walking to your car with your friends. You spot an elderly man lying on the ground. He is not breathing and has no pulse although he is warm. You ask a friend to call 999. His airway is clear. Your praecordial thump fails. The most likely way for his heart to resume beating is:
A 60-year-old man presents to the emergency department with shortness of breath for 3 hours and chest pain. He also complains of a right calf pain that he has had for 2 week.s. He has a past medical history of hypertension, recent stroke and disseminated lung cancer. His observations include temperature 37.0°C, pulse rate 112 bpm, blood pressure 100/54 mmHg, respiratory rate 26/min and saturations 87°/o on room air. There is no significant finding on chest examination. An electrocardiogram (ECG) shows sinus tachycardia and new right bundle branch block. A computed tomography (CT) pulmonary angiography confirmed massive pulmonary embolism. What is the most appropriate initial treatment?
A 55-year-old man is found to have a gastric ulcer following an endoscopy for left upper quadrant pain. A rapid urease test is positive for H. pylori infection. What treatment does this man need?
A 55-year-old man presents to his GP with increasing lethargy and polyuria. He has a past medical history of ischaemic heart disease and congestive cardiac failure. He smokes 30 cigarettes per day and drinks alcohol occasionally. He has a body mass index (BMI) of 32. His random blood glucose is 14.0 mmol/L and fasting blood glucose level is 9.0 mmol/L. Which of the following management is NOT appropriate in this patient?
A 79-year-old woman is started on high-dose steroids for giant cell arteritis. As therapy will likely be maintained for at least a year, she needs bone protection. The decision is made to start alendronate 70 mg once weekly. How would you advise her to take the tablet?