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3,531 questions
A 67-year-old man presents with painless rectal bleeding for the past 2 months. It occurs mainly on defecation, and is bright red in the pan and on the toilet paper. A digital rectal examination is unremarkable. What should your management be?
A 19-year-old female presents to the emergency department with a severe headache, photophobia, neck stiffness and a temperature. She is treated for bacterial meningitis with intravenous ceftriaxone. Blood cultures grow Neisseria meningitides. The next day, she starts bleeding from around her intravenous cannula and venepuncture sites. Which of the following investigation results would you NOT expect in disseminated intravascular coagulation?
A 66-year-old man presents to accident and emergency in a confused state accompanied by his wife. She states that the patient has become increasingly obtunded in the last 3 days and has not opened his bowels for the same period of time. She mentions he has been suffering from multiple myeloma, but is otherwise healthy. On examination, the patient has brisk tendon reflexes, dry mucosal membranes, reduced skin turgor and the eyes appear sunken. The most appropriate management is:
A 49-year-old man has recently been diagnosed with type 2 diabetes and is being carefully monitored. He has been advised to maintain a healthier diet and lifestyle, he attends a follow-up clinic and claims to have been following the diet stringently since his last appointment three months ago. The most appropriate investigation is:
A 30-year-old man, who has recently returned from holiday in Africa, presents to accident and emergency with a 7-day history of fever, sweats, malaise and lethargy. Thick and thin blood films detect Plasmodium falciparum. What is the most appropriate treatment?
A 59-year-old woman with advanced metastatic breast cancer presents to the emergency department with severe abdominal pain. She has not opened her bowels for 7 days and feels constipated. She has also noticed that she has been passing water more frequently but has not been incontinent. On rectal examination there is no loss of anal tone and normal sensation. What is the most likely diagnosis?
You are called in the middle of the night to see a 49-year-old man with known alcoholic liver disease admitted 2 days previously. He is shaking, sweating, tachycardic, apyrexial and believes he is seeing spiders crawling across the ceiling. What is the most likely diagnosis?
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 nausea and vomiting. On examination, he is tachycardic with a blood pressure of 105/60 mmHg. Blood tests show a urea of 15 mmol/L and a creatinine of 180 µmol/L. Results from a week earlier showed a urea of 4.0 mmol/L and a creatinine of 90 µmol/L. All other blood tests and arterial blood gas results are within the normal range. What is the most appropriate initial management of this patient?
A 35-year-old man presents with a 3-week history of pain and swelling in the tips of his fingers. He has no history of bowel problems, recent infection or skin disease, but his brother has Crohn's disease. On examination you find several swollen, red, tender distal interphalangeal USMLE IM2e/Diagnostic joints, and the nails have separated from the nailbed and have small pockmarks covering them. The rest of the examination is unremarkable. Which of the following diagnoses is most likely?
A 47-year-old woman presents to clinic after being referred from her GP for consistently elevated blood pressure. Her last reading was 147/93. The female does not report any symptoms but recently lost her job and attributes the elevated reading to stress. Her blood tests are as follows: Sodium 146, Potassium 3.4, Glucose (random) 7.7, Urea 4. The most appropriate investigation is:
A 60-year-old man presents to his GP with gradually increasing fatigue and some exertional dyspnoea. Blood pressure is 118/74 mmHg and pulse rate is 81/minute. There are no abnormal physical findings and on echocardiography the ejection fraction is 0.47. However, the clinical USMLE IM2e/Paraclinic impression remains one of early heart failure. Which of the foilowing circulating biomarkers would lend support to that conclusion?
A 69-year-old man, who is recovering from an emergency laparotomy for a ruptured duodenal ulcer, develops profuse offensive diarrhoea. His postoperative course has been complicated by chest infections and he has just been stepped down onto the main wards from the intensive care unit. Stool cultures have revealed C. difficile toxin. What is the most appropriate treatment?
A 39-year-old man presents with a three-month history of depression. The patient recently lost a family member and around the same period began to feel unwell with constipation and a depressed mood. He has started taking analgesia for a sharp pain in his right lower back that often radiates towards his front. The most appropriate investigation is:
A 48-year-old woman with a recent diagnosis of metastatic cancer of unknown primary, including metastasis to the sacral and thoracic spine, is currently being treated for lower back pain with regular paracetamol, diclofenac and oral morphine solution. She is receiving additional oral morphine solution rescue doses for her breakthrough pain. On review of her drug chart, she has received 60 mg of oral morphine solution over the past 24 hours. Which of the following is the most appropriate escalation for this patient's pain management?
A 71-year old woman presents to accident and emergency with pain in the right knee. This has been ongoing for the past five months but she is now finding it difficult to walk. Pain is usually worse after exertion. On examination, the right knee is swollen. There is a reduced range of active movement and palpable crepitus. What are the most likely findings on x-ray?
A 29-year-old man presents with a 4-week history of polyuria and extreme thirst. The patient denies difficulty voiding, hesitancy or haematuria, although the urine is very dilute. The patient does not believe he has lost any weight and maintains a good diet. No findings are found on urine dipstick. The most appropriate investigation is:
A 67-year-old man is discharged from hospital following an incision and drainage of a large abdominal wall abscess. He needs someone to help change his wound packing regularly, however he is immobile and lives alone. Which member of the multidisciplinary team would be most appropriate to help?
A 53-year-old man, who has had some lower back pain and sciatica into his right leg for the past year, presents with a 2-day history of leg weakness and severe pain. On examination, which of the following signs does NOT make you think of cauda equina syndrome?
A 22-year-old woman complains of dizziness and feeling light-headed. She works in an office and most frequently experiences this when standing up to visit the toilet. She has never fainted. The patient has lost 5 kg, but attributes this to eating more healthily. She has noticed a recent scar on the back of her hand which has started to turn very dark. The most appropriate investigation is:
A 69-year-old woman presents to accident and emergency in a distressed state. She is extremely breathless and an audible wheeze can be heard, frothy clear sputum is produced each time she coughs. A gallop rhythm and widespread wheezes and crackles are beard on auscultation. The most likely diagnosis is: