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3,531 questions
A 19-year-old woman complains of general malaise and lethargy. She has recently started university after a gap year in the Western Cape of South Africa and is now returning home to visit her parents. She felt feverish with a headache which has become considerably worse by the afternoon with nausea and vomiting. Supine flexion of the patient's neck causes unassisted knee flexion. The most likely diagnosis is:
A 20-year-old woman presents with a 3-day history of diffuse acute abdominal pain. The patient reports feeling generally unwell earlier during the week with a strange sensation in her mouth. She denies any recent travel history or sexual activity. On examination, skin turgor is reduced and a fruity odour can be smelt. The most likely diagnosis is:
A 75-year-old woman presents with confusion to accident and emergency, she was brought in by her neighbours who found her outside her house in her nightclothes during the middle of the day. She appears oedematous in appearance, particularly of her neck. The patient's hand is visibly shaking and while coughing a rust- coloured sputum is produced. Blood tests reveal a mild hyponatraemia while blood pressure is 110/82. The most likely diagnosis is:
A 52-year-old man presents to accident and emergency after collapsing at home. He appears pale on appearance with cold extremities. Blood pressure is 97/73 mmHg, heart rate 110 bpm, temperature 36.9°C and an ECG shows normal findings. Blood culture and urine culture are negative for any findings. He reports returning from a weekend break in Wales, but forgot to take his medication for Crohn's disease with him.. Themost likely diagnosis is:
A 27-year-old woman visits her GP complaining of a fever. She returned from India almost 2 weeks ago and had felt unwell but attributed this to jet lag. After suffering from a fever she rested for 2 days and on recovering returned to work as an accountant. After another 2 days she now reports waking up at night again with a high fever, feeling drowsy and confused. On presentation she appears unwell, pale and sweaty. The most likely diagnosis is:
A 35-year-old man complains of a three-month history of intermittent excruciating headaches. They are very variable and occur from once a month to three times a week. The headaches are associated with extreme anxiety and sweating. On examination, the patient's blood pressure is 152/95 mmHg and during palpation of the abdomen the patient's skin flushes red. The most likely diagnosis is:
A 47-year-old obese Asian man complains of a sharp pain on the left side of his chest with difficulty breathing. The pain started a few hours ago and does not radiate anywhere, the patient also reports feeling increasingly short of breath and became extremely anxious when he started coughing blood-stained sputum. He states he has been flying all week on business trips and is getting late for his next flight. The most likely diagnosis is:
A 53-year-old severely distressed and confused woman presents to accident and emergency with her husband. A collateral history reveals she has been suffering increasingly severe tremors, sweating and weight loss during the week. Since yesterday she has started to suffer from palpitations and increasing confusion. Blood pressure is 157/93 mmHg and there is an irregularly irregular pulse. The most likely diagnosis is:
A 57-year-old man complains of a two-month history of chest pain which has recently become more severe. The patient describes the pain as a tightness occurring in the centre of the chest which he most often notices when reaching the top of the stairs. The pain usually recedes after a short rest. In the last 2 weeks he has noticed the pain is more severe and, unless he is sitting down or sleeping, is present all the time. The most likely diagnosis is:
A 57-year-old woman complains of a headache and weakness on the right side of her body. The headache is normally worst first thing in the morning and is particularly painful on her left hand side. The weakness has occurred very gradually over several weeks and is most noticeable when lifting objects. On examination, her temperature is 38.5°C, she has recently had a left ear infection which is not causing any pain now. The most likely diagnosis is:
A 29-year-old woman is brought to accident and emergency after suffering from a seizure at work witnessed by a colleague. She reports the patient bas been unwell for the past week with headaches and nasal congestion, but refused any sick leave. The patient bas a temperature of 38.3°C, a swollen bulging eye and an ipsilateral gaze palsy. The most likely diagnosis is:
A 30-year-old man is brought to accident and emergency by his wife in a confused state. After an argument at home, the wife bad left the patient and on returning found him unconscious. She suspects he may have made a suicide attempt but had not thought to look for any pills or bottles close to the patient. While waiting to be seen, the patient suffers a seizure. On recovery, an examination shows the patient's temperature is 39°C, pulse is irregular, respiratory rate is 20 and the patient's pupils are dilated. An ECG recording reveals tachycardia and widened QRS complexes, while a blood gas is normal. The most likely substance ingested is:
A 49-year-old man is assaulted by a gang and is brought into accident and emergency. After resuscitation, he regains consciousness with a Glasgow Coma Scale (GCS) of 15. He has suffered multiple fractures of the left leg and left arm but remains stable. While in the intensive care unit, he becomes agitated and complains of difficulty breathing which does not improve despite high flow oxygen. You notice a widespread petechial rash. The most likely diagnosis is:
A 65-year-old man presents with a 25-minute history of severe chest pain that he describes as 'gripping' in nature. The pain does not radiate anywhere and is the most severe pain the patient has experienced. The patient is sweaty and anxious in appearance, tachycardic and has a normal blood pressure. An ECG shows hyperacute T-waves and serum creatinine kinase levels are not raised. The patient has a history of peptic ulcer disease but is otherwise healthy. The most likely diagnosis is:
Before the start of a ward round you asked to check the blood results of patients on the general medicine ward round. A new patient has the following results: Prothrombin time Normal, Partial thromboplastin time Prolonged, Bleeding time Normal, Platelet count Normal. What is the most likely diagnosis?
A 50-year-old woman is brought to accident and emergency by her son who has become increasingly worried about her confused state. Her son states she suffers from chronic hypertension but is poorly compliant with medication and has become increasingly confused over the past week and complaining of hallucinations. On examination, the patient's Glasgow Coma Scale (GCS) is 14, blood pressure is 210/120 mmHg, pulse is 112/min and there is papilloedema on fundoscopy. The most likely diagnosis is:
An 18-year-old woman is referred with the complaint of recurrent palpitations lasting 2-3 hours and terminating as abruptly as they started. She is otherwise well and finds the episodes uncomfortable but not especially distressing. Examination is entirely normal between attacks. The electrocardiogram (ECG) shows a PR interval of 0.1 seconds and slow upstrokes in the R waves of several leads. What is the most likely diagnosis?
A 12-year-old patient complains of easy bruising and nose bleeds, small ecchymoses can be seen on the patient's skin. The patient reports feeling ill in the last week with mild fever and a sore throat. The nose bleeds are not prolonged and stop soon after pressure is applied. A blood test shows a mild thrombocytopenia. The most likely diagnosis is:
A 30-year-old man presents to accident and emergency with a 5-day history of fevers, sweats and lethargy. On further questioning, he mentions that he has just returned from a 6 week trip to Tanzania. On examination his temperature is 40°C. What is the most likely diagnosis?
A 44-year-old man presents with non-specific symptoms of fever, shortness of breath and syncope. Blood tests show a raised erythrocyte sedimentation rate (ESR) and a transoesophageal echo shows an atrial myxoma. What is characteristically heard on auscultation in atrial myxoma?