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3,531 questions
A 17-year-old girl is brought into accident and emergency with generalized tonic- clonic seizure. Her mother had found her fitting in her bedroom about 20 minutes ago. The ambulance crew handover state that her sats are 96 per cent on 15 L of oxygen and they have given her two doses of rectal diazepam but she has not stopped fitting. What is the most appropriate management?
A 64-year-old man presents with a 2-day history of abdominal pain which he describes as constant, dull and around his umbilicus and occasionally migrating to his groin. He has a body mass index (BMI) of 27 and a past medical history of poorly controlled hypertension. Abdominal examination reveals a pulsatile and expansile mass just below the umbilicus. The most appropriate screening investigation is:
A 33-year-old woman attends her six-month follow-up appointment for headache. They are migrainous in nature but whereas she used to have them every few months, over the last three months she has experienced a chronic daily headache which varies in location and can be anywhere from 3-7/10 severity. Her last migraine with aura was two months ago. She takes co-codamol qds and ibuprofen tds. What is the best medical management?
A 45-year-old man with a strong family history of dilated cardiomyopathy presents with peripheral oedema, finger clubbing, jugular venous distension and pulmonary rales. A gallop rhythm is heard on auscultation Which investigation would not be useful in dilated cardiomyopathy?
A 58-year-old man presents with breathlessness, he reports feeling unwell over the last three months with nausea, vomiting and difficulty breathing. You notice his ankles are swollen and he has bruises on his arms. The patient mentions he has not been urinating as often as normal. The most appropriate investigation is:
A 21-year-old woman complains of urinary frequency, nocturia, constipation and polydipsia. Her symptoms started 2 weeks ago and prior to this she would urinate twice a day and never at night. She has also noticed general malaise and some pain in her left flank. A urine dipstick is normal. The most appropriate investigation is:
A 60-year-old man with metastatic adenocarcinoma of the lung, who has finished two cycles of palliative cisplatin/pemetrexed chemotherapy, presents with a 2-day history of fever and lethargy. On examination, he is pyrexial with a temperature of 38.8°C. What is the most appropriate next step?
A 33-year-old woman presents to accident and emergency with severe right flank pain. The pain started 3 hours ago and is not constant, occasionally moving towards her right iliac fossa. The patient also feels nauseous and has a low-grade fever. The most appropriate investigation is:
A 64-year-old woman attends your clinic with a 2-week history of jaundice. Over the last three months the patient has lost 10 kg. Associated symptoms include decreased appetite, dark urine and pale stools. On examination, the patient is jaundiced, her abdomen is soft and you can palpate a painless mass in the right upper quadrant. From the list of answers below, select the initial most appropriate investigation that you would request for this patient:
A 71-year-old right-handed male is brought in by ambulance at 17:50 having suffered a collapse. His wife came home to find him on the floor unable to move his right arm or leg and unable to speak. Her call to the ambulance was logged at 17:30. He has a past medical history of well-controlled hypertension, ischaemic heart disease and atrial fibrillation for which he is on warfarin. He had a hernia repair three months ago and his brother had a 'bleed in the brain' at the age of 67. What is the absolute contraindication to thrombolysis in this male?
A 74-year-old man with a history of hypertension, ischaemic heart disease and moderate congestive cardiac failure is admitted with a urinary tract infection and has developed acute renal failure. His potassium level is noted to be 5.5 mmol/L. Which of his following medications may be contributing to the raised serum potassium level?
A 19-year-old woman presents with an acute episode of feeling 11nwell. While in the middle of moving to a new house, she experienced an extremely severe pain near the back of her head. She denies any recent travelling, fever or neck stiffness. The most defmitive investigation is:
A 17-year-old boy suffered a generalized seizure at school and is brought to accident and emergency by ambulance. His teachers report he was well during the day but has suffered from repetitive ear infections and despite taking antibiotics during the week still suffered from headaches and ear discharge. On examination, he appears well but complains of headache, his temperature is 39°C and he is neurologically intact. A CT scan confirms a cerebral abscess and rapid culture tests confirm streptococcal infection. The most appropriate management is:
A 23-year-old woman complains that her right leg has become progressively stiff and clumsy over the last couple of weeks. She is worried as she has not been able to go to work for the last 4 days. On examination, tone is increased and there is a catch at the knee. She has six beats of clonus and an upgoing plantar. Power is reduced to 3-4/5 in the right leg flexors. There is no sensory involvement and the rest of the neurological exam is normal other than a pale disc on opthalmoscopy. On further questioning, she admits that she has had two episodes of blurred vision in her right eye in the last two years. Each lasted a couple of weeks from which she fully recovered. What is the most appropriate initial treatment?
A 24-year-old man is involved in a road traffic accident and rushed to accident and emergency accompanied by his mother who was unharmed. An examination shows severe abdominal injuries, peripheral cyanosis and cold extremities. The doctor on call decides a blood transfusion is necessary. The mother thinks the patient is blood group B negative but is unsure. The most appropriate blood group to give the patient is?
A patient on your ward is diagnosed with hepatocellular carcinoma. You are asked to perform a tumour marker level on this patient. Which of the foilowing tumour markers are elevated in hepatocellular carcinoma?
A previously fit and well 70-year-old woman has been admitted due to a fractured neck of femur, and she has recently returned to the ward after a cemented hemiarthroplasty. You are bleeped to the ward to see her, as it is noted that she has had only 30 ml urine output in the last 3 hours. She is asleep on the ward, with a patient-controlled analgesic device in situ. Her airway is intact and her respiratory rate is 12/min with normal saturations and good air entry bilaterally. Her pulse is 125 bpm with a blood pressure of 95/68 mmHg and she has delayed capillary refill. She has pale conjunctiva and a temperature of 37.3°C. She has a 12-hourly bag of normal saline running. Her catheter is draining concentrated urine. An abdominal examination is normal. Which of the following interventions would you try first to increase the urine output?
A 77-year-old woman presents to accident and emergency complaining of severe unilateral headache over the left side of her head. On examination, the left side of her scalp is painful to touch. Blood tests reveal a raised ESR and CRP. What is the most appropriate management?
A 32-year-old man presents to accident and emergency with a 1-day history of pain in the right knee. He also mentions that he has had a fever and is feeling generally unwell. On examination, the right knee is swollen, warm and extremely painful to move. What is the most appropriate next step?
A 45-year-old man presents with intermittent difficulty in swallowing for the last 4 months. This is associated with severe retrosternal pain and regurgitation. He has no risk factors or sinister signs for malignancy. What is the most im.portant investigation in this case?