Medical
Browse, search and filter 3,531 questions.
3,531 questions
A 39-year-old Indian man presents to his GP with a 5-week history of haemoptysis, night sweats and weight loss. Which of the following investigations can be used to confirm the diagnosis of tuberculosis?
A 32-year-old woman attends her GP for a routine medical examination and is noted to have a mid-diastolic murmur with an opening snap. Her blood pressure is 118/71 mmHg and the pulse is regular at 66 beats per minute. She is entirely asymptomatic and chest x-ray and ECG are normal. What would be the most appropriate investigation at this point?
A 41-year-old woman is referred for assessment after suffering a second pulmonary embolus within a year. She has not been travelling recently, has not had any surgery, does not smoke and does not take the oral contraceptive pill. She is not currently on any medication as the diagnosis is retrospective and she is now asymptomatic. What should be the next step in her management?
A 54-year-old woman presents to the emergency department with a 2-month history of intermittent right upper quadrant pain. The pain is sharp in nature and radiates round to the back. On examination there is no jaundice, no hepatomegaly and she is apyrexial. Liver function tests and an amylase are normal. She has no history of recent foreign travel. What is the most likely diagnosis?
A 51-year-old Caucasian male with poorly controlled hypertension presents to accident and emergency with confusion, nausea and vomiting. His daughter visits him weekly and called the ambulance on finding him in this state at home. Blood pressure measurement shows 200/140 mmHg. The most appropriate management is:
A 62-year-old male presents with palpitations, which are shown on ECG to be atrial fibrillation with a ventricular rate of approximately 130/minute. He has mild central chest discomfort but is not acutely distressed. He first noticed these about 3 hours before coming to hospital. As far as is known this is his first episode of this kind. Which of the following would you prefer as first-line therapy?
While on call you are called by a nurse to a patient on the ward complaining of light headedness and palpitations. When you arrive the patient is not conscious but has a patent airway and is breathing with oxygen saturation at 97 per cent. You try to palpate a pulse but are unable to find the radial or carotid. The registrar arrives and after hearing your report of the patient decides to shock the patient who recovers. What is the patient most likely to have been suffering?
Three months after liver transplantation for chronic hepatitis C infection, a 45-year-old man develops biochemical abnormalities suggestive of cholestatic hepatitis. Which of the foilowing evaluation strategies is most important for this patient at this time?
A 70-year-old man presents to his physician with complaints of chest tightness. The sensation is substernal, is brought on by exertion, and is relieved by rest. He is able to walk several blocks before he notes chest pressure. His medical history is remarkable only for hypertension and hyperlipidemia. His medications are hydrochlorothiazide, 25 mg daily, and aspirin, 325 mg daily. Which of the following statements is true for this patient regarding exercise treadmill testing?
A 64-year-old man presents to accident and emergency following a collapse. He describes a blackout, subsequently regaining consciousness when on the floor. He presently feels well and describes no other symptoms. However, he mentions that he has unintentionally lost some weight over the past few months. There is no past medical history. Blood tests reveal a haemoglobin level of 9 g/dL with a mean cell volume on 71 fL. The most appropriate next investigation of this patient is:
A 17-year-old boy is rushed to accident and emergency after breathing difficulties in a restaurant. The parents report the patient feeling unwell after eating a cake containing nuts. The patient has swollen lips and tongue and an audible wheeze is heard. The most appropriate first-line treatment is:
A 78-year-old retired groundskeeper presents with a 2 cm skin lump on his temple. He is unsure how long it has been there. It appears to have a rolled, shiny edge with telangiectasia and a central ulcerated area. Which of the following is the most likely diagnosis?
A 25-year-old woman presents to your clinic complaining of lower abdominal pain and periods of constipation alternating with episodes of diarrhea. Her previous physician diagnosed her with an irritable bowel after an extensive evaluation. She takes a selective serotonin reuptake inhibitor for depression but has no other significant medical history. Which of the following abnormalities is NOT present in patients with functional gastrointestinal disorders?
A 52 year-old woman has been treated for several years with amlodipine and lisinopril for what has been presumed to be primary hypertension. She is seen by her GP having complained of persistent left loin pain. Her BP is 150/95 mmHg. She is tender in the left loin and both kidneys appear to be enlarged. On urine dipstick testing, there is microscopic haematuria. Which of the following is likely to be the most appropriate investigation at this point?
A 56-year-old man presents to your clinic with symptoms of exertional chest tightness which is relieved by rest. You request an ECG which reveals that the patient has first degree heart block. Which of the following ECG abnormalities is typically seen in first degree heart block?
A 54-year-old man presents with a 3-day history of left lower quadrant pain. He reports that his appetite has decreased and that he has been experiencing mild nausea. He denies having any significant change in bowel function, hematochezia, or melena. On examination, his temperature is 101.3° F (38.5° C) and his blood pressure is 145/84 mm Hg. He has significant tenderness in the left lower quadrant, with some mild local fullness. No rebound is appreciated. The white blood cell count is 13,400. What is the most appropriate diagnostic test for this patient?
A 78-year-old woman is admitted to your ward following a 3-day history of shortness of breath and a productive cough of white frothy sputum. On auscultation of the lungs, you hear bilateral basal coarse inspiratory crackles. You suspect that the patient is in congestive cardiac failure. You request a chest x-ray. Which of the following signs is not typically seen on chest x-ray in patients with congestive cardiac failure?
A 10-year-old boy is evaluated for edema. He developed unilateral left upper and lower extremity edema 1 year ago. On review of systems, abdominal swelling and occasional diarrhea are noted. The physical examination is remarkable for unilateral edema and abdominal shifting dullness to percussion. A complete blood count shows lymphopenia. The serum albumin level is low at 1 g/dl. Urinalysis shows no protein; liver function tests are within normal limits. Which of the following would be the most likely finding on small bowel biopsy for this patient?
A 49-year-old man presents with right upper quadrant abdominal pain that began 8 hours ago. The pain is constant and is associated with nausea, vomiting, and fever. Over the past few months, he has had intermittent episodes of similar pain, but those were less intense, resolved USMLE IM2e/Paraclinic spontaneously within 1 or 2 hours, and were never associated with vomiting or fever. Results of physical examination are as follows: temperature, 101.3° F (38.5° C); blood pressure, 130/90 mm Hg; pulse, 90 beats/min; and respirations, 16breaths/min. The patient looks tired and moderately uncomfortable. Bowel sounds are present, but he has right upper quadrant tenderness. There is no palpable liver or gallbladder. Laboratory results are remarkable for a white blood cell count of 14,000, with a left shift. Bilirubin, amylase, and alkaline phosphatase levels are normal. Which of the foilowing is the best diagnostic imaging test for this patient?
A SO-year-old man comes to your clinic complaining of intermittent upper abdominal pain that radiates to his back and worsens with meals. He has a long history of binge drinking. He notes that lately he has been losing weight and that his stools have been loose. Which of the following should be the first test to determine whether this patient has chronic pancreatitis?