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3,531 questions
A 42-year-old woman attends to her GP complaining of non-specific abdominal pain and an increasing abdominal girth. She is found to have a large mass in her right lower abdomen and ascites on transvaginal ultrasound imaging. Which of the following tumour markers would be most useful?
A 34-year-old woman with systemic lupus erythematosus (SLE) has had multiple miscarriages and now presents with a painful right swollen leg. A compression ultrasound scan confirms deep vein thrombosis. Which blood test may now be indicated?
A 42-year-old male from El Salvador complains of several months of dyspnea on exertion. Physical examination reveals an.elevated jugular venous pressure, clear lungs, a third heart sound, a pulsatile liver, ascites, and dependent edema. Chest radiography reveals no cardiomegaly and clear lung fields. An echocardiogram demonstrates normal to mildly decreased left ventricular systolic function. The initial diagnostic workup should include all the foilowing except?
A SO-year-old man presents to the cardiology clinic for review. His brother died suddenly of a cardiac arrest while playing S11nday league soccer, and was found on post-mortem to have an underlying diagnosis of hypertrophic obstructive cardiomyopathy (HOCM). Which of the following is the most appropriate way to screen the patient?
A 63-year-old man is admitted to the emergency department with severe dyspnoea. He is a longstanding smoker of 40 years. His observations are pulse rate 130 bpm, respiratory rate 36/min, oxygen saturation of 85o/o on 24% oxygen via a venturi mask and temperature 38.2°C. Chest examination reveals reduced air entry on both lungs with coarse crackles on his left lower lobe. Despite immediate maximum standard medical treatment on controlled oxygen therapy, his arterial blood gas still shows persistent acidosis with a PaC02 of 8 k.Pa. Which of the following would NOT be a required inclusion criterion for non-invasive ventilation?
A 75-year-old man is referred for total hip replacement. He has a history of hypertension and angina and has suffered a myocardial infarction some 8 years earlier. Current medication includes atenolol 50 mg daily, ramipril 10 mg daily, aspirin 75 mg daily and isosorbide dinitrate 60 mg. Blood pressure at the preoperative assessment was 160/80 mmHg but he maintains that his readings with the general practitioner have been normal. He last had an exercise test some 3 years earlier and managed 8 min with no significant electrocardiogram (ECG) changes. Which one of the following investigations in addition to standard assessment would be most appropriate for the preoperative assessment of this patient?
A 53-year-old bus driver presents with a history of chest pain at rest. Initial ECG shows minor ST-segment depression in the lateral leads. Cardiac enzymes, including troponin, are normal. He has known angina, with angiography 3 years previously demonstrating minor right coronary artery disease. He is commenced on aspirin, ab-blocker and a statin. His symptoms settle over 24 hours, 12 hr troponin is normal, and following mobilisation he is discharged home. He needs to know how this episode might affect his future employment. Assuming his condition remains stable with no further symptoms, what would be hte next stage of investigation?
A 47-year-old woman presents complaining of dark stools and painful fingers on both hands. She appears plethoric and complains of severe itching, often when she is washing. A large liver and spleen is palpable. You suspect features of polycythaemia rubra vera and measure red cell mass and erythropoietin levels among other tests. Which of the following is likely to be most accurate in this patient?
A 22-year-old-woman presents to AE with a 4-day history of chest pain. She has been unwell with an influenza-like illness for the last week. The ECG shows widespread ST elevation in the inferior, anterior and lateral leads. What ECG changes would you expect to see in the next week or two?
A 52-year-old man with a history of alcohol excess presents to his GP because he cannot fully extend his ring finger on his right hand (neither actively nor passively). Since the imger is permanently partially flexed he can no longer place his hand flat on a flat surface. Which of the following is the most likely diagnosis?
A 65-year-old man with a longstanding diagnosis of chronic obstructive pulmonary disease has been reviewed by his GP for deteriorating liver function tests and clinical signs and symptoms of cirrhosis. What investigation should the GP arrange?
A 59-year-old woman with known polycythaemia vera presents to the emergency department with right upper quadrant pain, tender hepatomegaly and gross ascites, which has come on suddenly. There is no jaundice. What is the next most appropriate investigation?
A 64-year-old woman is an inpatient on a surgical ward following an above- knee amputation. The nursing staff said she vomited earlier and she has been unresponsive since her operation a few hours ago. On examination, you noticed her pupils are small and she has a respiratory rate of 5 breaths/ min. Which of the following is the most likely reason for this clinical picture?
A 52-year-old man with hyperthyroidism, vitiligo and a 30 pack/year smoking history, presents to hospital with an acute clumsiness of his right hand. Neurological examination reveals normal cranial nerves, and the only abnormal feature on the limb exan1ination is some past pointing and dysdiadochokinesis in the right hand. Diffusion-weighted magnetic resonance imaging (MRI) reveals a small right-sided cerebellar infarct. Which of the following investigations is unlikely to be helpful?
A 69-year-old man recently diagnosed with metastatic prostate cancer presents with weakness in his legs and urinary retention. He has had back pain for years but in the last 24 hours this has become very severe in his lower back. On examination he has a sensory deficit, loss of anal tone and poor sensation in the skin around the anus. When catheterised he has a residual volume of 1.5 L. Which of the following is the most informative initial investigation?
A 35-year-old homeless man presents to the emergency department in a state of unconsciousness. He was fitting when the ambulance crew got to him 20 minutes ago, and a friend at the scene estimated that he had started fitting ''around 15 minutes before''. His friend informed the ambulance crew that he is a known epileptic and you find a pack of phenytoin on him. He looks dishevelled and smells of alcohol. He has a blood pressure of 170/95 mmHg and temperature 37.9°C. On examination there is a quiet systolic murmur, though it is difficult to fully characterise. Which of the following investigations will be most useful at this stage?
90% A 34-year-old woman, who is known to be human immunodeficiency virus (HIV) positive, presents with multiple lesions on her face. The lesions are raised and shiny, non-tender and around 3 mm in diameter. They have an umbilicated centre. What is the most likely diagnosis?
A 78-year-old woman presents with palpitations that began an hour ago. She feels clammy to the touch. Whilst she is clutching your hand and telling you her past medical l1istory, you check her observations on the bedside monitor. You notice that her heart rate is 230 bpm and regular. The QRS complexes are narrow and no P-waves are noted. What is the most likely arrhythmia?
A 60-year-old man presents to accident and emergency with sudden onset pain in the right metatarsophalangeal joint. He is unable to walk without a stick. On further questioning, the patient reports experiencing two similar episodes in the past. Blood tests reveal a raised orate. What is the most appropriate treatment?
A 53-year-old woman with hypertension presents with muscle weakness and painful cramping. She admits some confusion with her new medication spironolactone after a recent dosage change, and may have taken more than the new prescribed dose. On examination, the patient appears well, an ECG shows absent p waves and widened QRS complexes. The most appropriate treatment is: