Medical
Browse, search and filter 3,531 questions.
3,531 questions
A 59-year-old obese woman underwent a coronary artery stent procedure. She is a well-controlled type 2 diabetic. The operation was successful. However, after lweek during recovery, the patient complained of severe chest pain and shortness of breath. Her heart rate was 115 bpm and blood pressure 107/89 mHg. Following resuscitation of the airway, breathing and circulation, an electrocardiogram (ECG) showed sinus tachycardia and right axis deviation. The most appropriate treatment is:
A seven-year-old girl is brought to accident and emergency by her mother because of a nose bleed that keeps on bleeding despite pressure and ice-packs. Petechiae and ecchymoses can be seen on examination and the mother reports the child bas recently recovered from a throat infection. You suspect the patient is suffering from immune thrombocytopenic purpura and organize tests to measure platelets (Pit), bleeding time (BT), prothrombin time (PT) and partial thromboplastin time (PTT). Which of the following is the most appropriate result?
A 65-year-old Asian man with type 2 diabetes complains of central chest pain which he describes as severe and crushing in nature. On appearance, the patient appears anxious, sweaty and has difficulty breathing. The most appropriate first- line treatment is:
A SO-year-old overweight pub landlord presents with an acutely painful swollen red hot first metatarsophalangeal joint on the left. You suspect gout. Which of the following would confirm this on microscopy of a joint aspirate?
A 52-year-old woman who has recently finished a course of chemotherapy for metastatic adenocarcinoma of the lung presents to accident and emergency following a fall at home. She mentions that her legs have been feeling heavy for 2 days. On examination there is reduced power through the lower limbs. Her lower limb reflexes are brisk and she has upgoing plantars. On examination of the abdomen, there is a palpable bladder. There is a sensory level below Ll. What is the most important diagnostic investigation?
A 26-year-old man with a past medical history of asthma presents to accident and emergency with difficulty breathing. He has a respiratory rate of 35 bpm, heart rate 120 bpm and difficulty in answering questions. On auscultation, a polyphonic wheeze is heard and SpO2 is 93 per cent. The patient is unable to perform a peak expiratory flow rate (PEFR). The most appropriate treatment is:
A 22-year-old unconscious man is brought into accident and emergency. He was found lying alone on the street by passers-by who called the ambulance and the crew mention seeing needles on the floor. The patient's Glasgow Coma Scale is 12, he has a respiratory rate of 10 and blood pressure of 97/65 mmHg. During your examination you notice pinpoint pupils. The most appropriate treatment is:
A 79-year-old woman presents to her GP with pain in the left knee. This is particularly bad in the evenings and is stopping her from sleeping. The GP explains that her discomfort is most likely due to osteoarthritis and arranges for her to have an x-ray of the knee. Which of the following descriptions are most likely to describe the x-ray?
A 39-year-old Indian man presents to accident and emergency with a 6-week history of haemoptysis, night sweats and weight loss. Chest x-ray reveals some shadowing in the left upper zone. What is the most appropriate diagnostic investigation?
A 28-year-old woman is rushed to accident and emergency in a confused state. Her partner reports seeing the patient vomiting and breathing very rapidly before falling ill, at which point he called the ambulance. Empty aspirin packets were found close to the patient, the partner estimates it has been approximately 45 minutes since the patient may have ingested the pills. The most appropriate first- line management would be:
A 45-year-old woman presents to the rheumatology outpatient clinic with a three- month history of stiff hands and wrists. She mentions that the pain is particularly bad first thing in the morning. On examination, the wrists, metacarpophalangeal joints and proximal interphalyngeal joints are swollen and warm. A diagnosis of rheumatoid arthritis is suspected. Which of the following investigations is most specific for confirming the diagnosis?
A 59-year-old man, who has completed five cycles of chemotherapy for metastatic colorectal carcinoma, presents to accident and emergency complaining of feeling generally unwell. On examination, he is pyrexial at 38.9°C and there are crepitations in the right lung base. What is the most urgent investigation?
A 29-year-old man presents to his GP complaining of being constantly thirsty, tired and visiting the toilet more often than usual during the last 4 days. He has noticed his clothes have become more baggy and he now needs to tighten his belt. His parents both have diabetes requiring insulin therapy. A fasting plasma glucose result is most likely to be:
Following a colonic resection, a 72-year-old woman becomes unwell with acute confusion, pyrexia, tachycardia and hypotension. The patient has had a difficult postoperative period, which has included an admission to ITU for the management of a chest infection. Blood cultures are sent and grow methicillin-resistant Staphylococcus aureus (MRSA). The patient is placed in isolation and barrier nursing is implemented.. What is the most appropriate management of this patient?
You are informed that one of your ward patients has been breathless over the last hour and has been quite anxious since her relatives left after visiting. The patient is a 67-year-old woman who was admitted 6 days ago for a left basal pneumonia which has responded well with intravenous antibiotics. Her past medical history includes dementia and hypertension. You are asked by your registrar to interpret the patient's arterial blood gas (ABG) measurements taken during her tachypnoea: pH 7.49 k.Pa, P02<w:t>14.1, PC02 3.1 k.Pa, HC03 24. From the list of answers below, choose the most appropriate ABG interpretation:
A 33-year-old man complains of a tingling sensation in his hands for several months which occasionally awakens him during sleep. The patient has noticed he has gained weight and no longer wears his wedding ring as it has become too tight. You notice the patient is sweating while speaking to you and has quite a large jaw, furrowed tongue and large hands. His blood pressure reading is 142/91 mmHg. The most appropriate investigation would be:
A SO-year-old man with type 2 diabetes undergoes a prosthetic aortic valve replacement after suffering from congestive heart failure due to native valve endocarditis. Following the operation, he presents with fever, janeway lesions, splinter haemorrhages and night sweats. The most definitive investigation for prosthetic valve endocarditis is:
A 19-year-old medical student presents to his GP during fresher's fortnight. He is complaining of neck stiffness, headache and sensitivity to light. On examination, a non-blanching, petechial rash is observed on the trunk. What is the most appropriate immediate management?
A 23-year-old final year law student presents to the GP with a cough productive of foul green sputum. He also complains of breathlessness on exertion. He has had an average of five respiratory tract infections per year for the past 2 years. As a child, he could not tolerate dairy products. On examination, finger clubbing is present and there is dullness to percussion of the right upper lung zone with widespread bilateral wheeze. What is the most probable diagnosis?
A 40-year-old man presents to accident and emergency having returned from a holiday to India a week ago. He has subsequently been unwell with nausea and reduced appetite. Over the past 2 days he has become jaundiced. On examination, he is apyrexial and there is a palpable liver edge. Liver function tests reveal a raised ALT, AST and bilirubin. A diagnosis of hepatitis A is suspected. What is the most appropriate treatment?