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3,531 questions
A 54-year-old male with type 2 diabetes mellitus reports 3 months of exertional chest pain. His physical examination is notable for obesity with a body mass index (BMI) of 32 kg/m2, blood pressure of 150/90, an S4, no cardiac murmurs, and no peripheral edema. Fasting glucose is 130 mg/dL, and serum triglycerides are 200 mg/dL. Which of the following is most likely in this patient?
A 55-year-old woman presents with mild cognitive impairment and disinhibition without significant mood change. She also has falls and urinary incontinence. She has no major past medical history or medications, and has never smoked or drank much alcohol. On examination, there are no cranial nerve or arm defects, however the legs appear to have increased tone, upgoing plantars and clonus bilaterally with some weakness of hip and knee flexion bilaterally. Which of the following diagnoses may explain the picture?
A 59-year-old man is admitted to the emergency department following a fall. He complains of increased tiredness and jerking movement of his legs, which led to his fall from the staircase. He is a smoker. On arrival, he has an oxygen saturation level of 76% in air, and an arterial blood gas reading-demonstrates: pH 7.40, Pa02 6 kPa, PaC02 9.3 kPa, HC03 35 mmol/L on room air. His respiratory rate was 20/min. What does this blood gas result show?
You find an 80-year-old man collapsed in the street. He is unresponsive and is making a snoring sound. An ambulance has been called but has yet to arrive. Which of the following is the best course of action?
A 34-year-old woman presents to the GP complaining of a new rash. The skin under her arms and on the back of her neck is dark and velvety in texture. She has a past medical history of diabetes for which she takes insulin. What is the most likely diagnosis?
A 64-year-old man presents to the emergency department with a large rectal bleed and left-sided abdominal pain. He has a long history of constipation. He has a temperature of 38.4°C and a heart rate of 110 bpm. What is the most likely cause?
An SO-year-old man attends the general practice for an annual check-up of his hypertension. He gingerly tells you all about his ''left ventricular hyperthingummy''. You check him and his records for confirmatory signs and symptoms. Which of the following is NOT a sign of left ventricular hypertrophy?
You are examining a tearful young child who has fractured her arm. On auscultation you hear an ejection systolic murmur. There is no cyanosis. Which of the following prevents you reassuring her calm dad that his daughter has no serious heart problem?
A 79-year-old woman who was admitted to hospital with a fractured right neck of femur 1 wee.k ago suddenly becomes acutely unwell on the ward 6 days after her operation. She complains of sudden-onset of shortness of breath and chest tightness. The pain is exacerbated by deep breathing. She has a past medical history of hypertension, hypercholesterolaemia and asthma. Her observations include temperature 37.8°C, pulse rate 108 bpm, blood pressure 96/66 mmHg, respiratory rate 26/min and saturations 89o/o on room air. On examination, her chest is clear to both auscultation and percussion. An electrocardiogram (ECG) shows sinus tachycardia without bundle branch block. What is the most likely diagnosis?
A 63-year-old woman presents in accident and emergency with a 3-day history of worsening abdominal pain and mild flank pain. Examination reveals pain in the suprapubic region, but otherwise the abdomen is soft with no masses. The patient denies any other symptoms, such as dysuria, but mentions she has had difficulty passing urine in the last week and is only able to provide a small urine sample which is odorous and bloody. She has no other medical problems, but admits to being a long-term smoker. An ultrasound scan of renal system is most likely to show:
A 43-year-old man presents with intermittent haematuria. On examination of the abdomen, bilateral masses are felt and an ultrasound reveals polycystic kidneys. You explain the syndrome to him. He is concerned that his son may develop the disease. He does not believe his wife suffers from the condition. What is the probability that his son will develop the disease?
A 41-year-old woman with type 2 diabetes attends a hypertension clinic. She has been doing well on metformin and has maintained good glycaernic control alongside dietary changes and regular USMLE IM2e/Emergency physical exercise. She has been meeting her HbAlc targets consistently. However, her blood pressure has been poorly controlled despite lifestyle changes and is currently 157/97 mmHg. The most appropriate first- line therapy is:
A 62-year-old woman with metastatic breast cancer, including bone metastases, presents to accident and emergency with sudden onset back pain and difficulty walking. An urgent MRI of the spine confirms cord compression at the level of Ll-L2. What is the most appropriate initial management?
A 68-year-old obese Asian man is seen in the hypertension clinic. His blood pressure is 151/93 and he suffers from poorly controlled type 2 diabetes. Blood results demonstrate elevated serum urea and creatinine. An ultrasound scan shows asymmetry between the two kidneys and on examination audible abdominal bruits are auscultated. Urine dipstick did not detect any blood or protein. The best investigation is:
A 38-year-old woman presents to her GP with a 2-week history of dysuria, haematuria and shortness of breath. She suffers from chronic headaches and has been taking ibuprofen in order to treat them. She has a history of cardiovascular disease in the family and a friend recomm.ended she use aspirin to keep healthy. The most appropriate investigation is:
You review a 26-year-old woman who attends the cardiology clinic with her husband. They wish to start a family, but they have been referred by the GP as he is worried that she has a history of heart disease. Which of the following cardiovascular conditions is an absolute contra-indication to pregnancy?
A 60-year-old man presents with visual problems and dizziness. The dizziness started suddenly, he sees the room spinning around and he has noticed he keeps bumping into things on his right. His blood pressure is 159/91, heart rate 72. On examination, there is nystagmus and dysdiadochokinesia. Where is his stroke?
A 24-year-old man presents with a four-month history of abdominal pain which has been getting worse. The patient describes the pain as generalized, dull in character and does not radiate but often occurs alongside loin pain. An irregular mass is palpable in both flanks and a mid-systolic click can be auscultated. The most appropriate investigation is:
A 64-year-old man suffers an anterior myocardial infarction. A few hours later, his pulse rate is noted to be 46/minute and his blood pressure 94/59 mm Hg. He is short of breath and has slight central chest pain. The monitor showed sinus bradycardia. What would be your choice of management?
A 72-year-old man with known epilepsy and hypertension is admitted with pneumonia. His drug history includes aspirin, phenytoin, bendrotlumethiazide and amlodipine. His heart rate is 67, blood pressure 170/93, sats 96 per cent on 2 L of oxygen. Neurological examination is normal. His doctor requests blood tests including phenytoin level. What is the correct indication for this test?