Medical
Browse, search and filter 3,531 questions.
3,531 questions
A SO-year-old Asian man is referred to the diabetes clinic after presenting with polyuria and polydipsia. He has a BMI of 30, a blood pressure measurement of 137/88 and a fasting plasma glucose of 7.7 mmol/L. The most appropriate first-line treatment is:
A 41-year-old man has been recently diagnosed with type 2 diabetes and has been following a plan of lifestyle measures to improve his diet and increase his level of exercise. On returning to clinic, his BMI is 23, fasting plasma glucose 9.0 mmol/L, blood pressure 133/84 mmHg and HbAlc of 7.1 per cent. The most appropriate treatment option is:
A 19-year-old woman presents with concerns about changes to her facial appearance, in particular her nose and jaw seem quite large, she is also quite sweaty and despite using antiperspirants is finding it difficult to control and is afraid of embarrassment at university. A glucose tolerance test is performed and found to be raised. The most appropriate management would be:
A 40-year-old woman presents to the rheumatology outpatient clinic with a three- month history of stiff hands and wrists. She mentions that the pain is particularly bad first thing in the morning. On examination, the wrists, metacarpophalangeal joints and proximal interphalangeal joints are swollen and warm. A diagnosis of rheumatoid arthritis is suspected. Blood tests for rheumatoid factor return as positive. What is the most appropriate management?
A 72-year-old diabetic man is admitted to AE with a 40 minute history of central, crushing chest pain. The pain eases after an hour with bedrest, oxygen and morphine. ECG shows mild anterior ST flattening. The troponin T level is slightly raised. What would be the optimal management of the underlying cause of his chest pain be besides usual medical measures?
examination, bony nodules are palpable on the distal interphalangeal joints of both his hands. The right knee is swollen and there is a reduced range of active movement. X-rays show reduction in the joint space, subchondral sclerosis and osteophyte formation. What is the most appropriate treatment?
A 23-year-old man presents to the rheumatology clinic with lower back and hip pain. These have been occurring every day for the past two months. Pain and stiffness are worse in the mornings. He also mentions that his right heel bas been hurting. He is previously fit and well, but had occasions of lower back pain when he was a teenager. His symptoms have stopped him from playing tennis. Recent blood tests organized by his GP have shown a raised C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). What is the most appropriate treatment?
A 24-year-old woman presents to her GP complaining of cold hands and feet. This has been ongoing for the past three months and is especially bad when she goes out in the mornings and may last for hours. On further questioning, she mentions that her hands sometimes turn blue or red and that gloves are unhelpful. She has otherwise been feeling well and has no past medical history. What is the most appropriate treatment?
A 59-year-old man presents to his GP with sudden onset severe pain, tenderness and swelling of the first metatarsophalangeal joint. He is known to suffer from acute gout and has had several previous similar episodes. What is the most appropriate treatment?
A 70-year-old woman complains of tiredness, fatigue and weight loss. Blood tests reveal an elevated WCC and on examination splenomegaly is palpated. Cytogenetics are positive for the Philadelphia chromosome and the patient is diagnosed with chronic myeloid leukaemia. The most appropriate treatment is:
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 22-year-old man with testicular cancer has undergone an inguinal orchidectomy. Histology has confirmed teratoma. A preoperative CT staging scan has shown involvement of the para-aortic lymph nodes. Which of the following treatments is the best post-operative option?
A 51-year-old man with a recent diagnosis of pancreatic carcinoma with metastases to the liver and omentum is about to commence gemcitabine chemotherapy. Prior to his first cycle he mentions that he is getting increasing severe abdominal pains. He is currently taking paracetemol for this, which eases the pain but is now becoming less effective. The most appropriate analgesia for this patient is:
A 57-year-old man with metastatic adenocarcinoma of the lung is attending for cycle three of his palliative pemetrexed/cisplatin chemotherapy. During his cisplatin infusion, he noticed his arm becoming painful, swollen and red at the cannula site. The most likely cause of this is:
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 34-year-old diabetic woman attends your hypertension clinic to discuss her blood pressure control. She is currently following lifestyle advice and has started to lose weight and maintain good glycaemic control. Her blood pressure was 155/93 mmHg at her last clinic appointment and is now 150/90 mmHg. She informs you she has recently become pregnant, which was planned, and intends to keep the baby. The most appropriate first-line therapy is:
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 SO-year-old woman presents to accident and emergency complaining of excessive lethargy. In addition, she mentions that she has been constipated. On examination, there are clinical features of dehydration. Blood tests have revealed a corrected calcium of 3.3 mol/L. Her chest x-ray shows bilateral streaky shadowing throughout both lung fields. She is given 3 L of saline in 24 hours after admission. The following day her blood tests are repeated and her corrected calcium level is now 3.0 mmol/L. Results of parathyroid hormone levels and thyroid function tests are still awaited. What is the most appropriate management?
A 28-year-old woman has noticed a change in her appearance; most notably her clothes do not fit properly and are especially tight around the waist. Her face appears flushed and more rounded than usual, despite exercising regularly and eating healthily her weight has steadily increased over the last 3 weeks. On visiting her GP, he notices her blood pressure has increased since her last visit and she has bruises on her arm. She is especially worried about a brain tumour. The most appropriate investigation would be:
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?