Medical
Browse, search and filter 3,531 questions.
3,531 questions
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 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 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?
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 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 70-year-old man presents with multiple widespread tense blisters measuring between 0.5 cm and 5 cm in diameter. They are localised mainly to the arms and legs, with some lesions on the chest. They appeared over weeks, preceded by itchy urticarial lesions. A few lesions have burst and have left not much behind. There is a history of osteoarthritis of the knees for which he takes diclofenac, and he has not changed any medication in the past year. A subsequent biopsy of a bulla shows splitting at the dermoepidermal junction. What is the 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 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 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 obese woman is not coping at home and presents to the emergency department foilowing a fall. On examination, she has a weak, regular pulse and an ejection systolic murmur. You try to lean her forward and palpate her apex beat in expiration but she gets flustered and complains of a sore back and shortness of breath. A neurological examination is unremarkable and her haemoglobin level is 13.2 g/dl. What is most likely wrong with her?
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?
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?
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?
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?
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 32-year-old man is diagnosed with Hodgkin's lymphoma following a recent history of weight loss and night sweats. Computed tomography (CT) staging scan shows disease in the mediastinum bilaterally and some abdominal lympbadenopathy, including the spleen, but no evidence of disease in extranodal sites. What is his stage of disease?
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 38-year-old man presents for review. His only previous history of note has been recurrent shoulder subluxation. His main complaints are tiredness and increasing dyspnoea on exertion. The nursing clerking on admission notes that he seems very tall and thin, his height is described as 1.93 m (6ft 4 inches). On examination his blood pressure is 165/70 mmHg, he has left ventricular hypertrophy, a low-pitched apical diastolic murmur and an early systolic apical ejection murmur. What diagnosis fits best with this clinical picture?
An 82-year-old man was admitted to the Emergency department from a local church service. He fainted and another parishioner, who is a trained first-aider, reported that he was pulseless for a few seconds after the attack. On examination his blood pressure was 165/95 mmHg (past history of hypertension), he had no murmurs on auscultation of the chest and carotid auscultation was also normal. Outpatient 7-day ambulatory cardiac rhythm monitoring was arranged, which is now reported as normal. What diagnosis fits best with this presentation?
A 32-year-old man presents to the GP 4 days after an episode of painless haematuria, 2 weeks following a sore throat. He says he now feels he is producing less urine than usual and that it is brown. He denies any weight loss or fatigue, and has no family history of urological malignancy. On examination, he has a blood pressure of 155/90 mmHg, +++ blood on urine USMLE IM2e/Diagnostic dipstick, and blood tests reveal a creatinine of 170 µmol/L and normal electrolytes. What is the clinical picture most consistent with?