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3,531 questions
An 18-year-old woman presents to accident and emergency with a 5-day history of fevers, malaise and severe sore throat. On examination, she has a temperature of 40°C and her tonsils are inflamed with visible palatal petechiae. In addition, her cervical lymph nodes are palpable. A full blood co11nt shows a raised lymphocyte co11nt. What is the most likely diagnosis?
A 45-year-old man presents to accident and emergency with back pain. He works as a builder and the pain started after he had moved a cement mixer. On presentation, he is in considerable distress and unable to walk. He has not passed urine or opened his bowels since the incident. On peripheral neurological exa1nination of the lower limbs, power is reduced throughout due to the pain. Sensation is preserved except for around the perineum. On digital rectal exam, there is poor anal tone. What is the most likely diagnosis?
A 17-year-old anxious Chinese boy presents to clinic with a 1-day history of haematuria. He first noticed the abnormality after a rugby match. His blood pressure is 123/75 mmHg. There is nothing of note on examination and the patient denies any recent illness or on-going medical problems. Urine dipstick confirms the presence of blood and protein. The most likely diagnosis 1• s:
A 39-year-old woman presents to her GP with a 3-month history of pain in the hands. She mentions that her hands have been particularly stiff in the mornings after waking up. On examination of the h.ands, there is pain on palpation of the proximal interphalangeal joints and metacarpophalangeal joints. What is the most likely diagnosis?
A 30-year-old woman, who is 8 weeks pregnant, presents to accident and emergency with PV bleeding and crampy abdominal pain. She has a past medical history of a right-sided deep vein thrombosis and two previous miscarriages. She is sent to the early pregnancy assessment unit, where ultrasound confirms miscarriage. What is the most likely underlying diagnosis?
A 44-year-old man presents with a 3-day history of haemoptysis. He has suffered from a chronic cough in the last three months, but has only recently noticed blood in the sputtim. He denies any medical problems and does not drink or smoke. A urine dipstick is positive for haematuria and proteinuria and inspiratory crackles are ausculated over both lung bases. Blood results confirm the presence of anti- glomerular basement membrane antibodies and blood pressure is 125/86 mmHg. The most likely diagnosis is:
A 26-year-old woman presents with an erythematous, palpable rash present on her feet, thighs, palms and soles. The rash is not itchy or painful. She mentions a dull pain in her elbows and knees whenever she moves. A full blood count is normal and a urine dipstick is positive for haematuria. The most likely diagnosis is:
A 68-year-old woman presents to her GP with headaches and visual disturbance. She has also noticed that she gets an itchy rash when she gets out of a hot bath. On examination she has a ruddy complexion and a palpable spleen. Her only previous medical history is gout. Initial blood tests reveal a raised packed red cell volume with a raised red cell mass, along with a raised white cell count and thrombocytosis. What is the most likely diagnosis?
A 19-year-old footballer has collapsed on the pitch. His airway is clear and he is brought to the emergency department, where he begins to recover and denies that he has chest pain. He has never had anything like this before. Which of the following is the most likely diagnosis?
A 69-year-old man presents to the emergency department with ongoing chest pain. He has a past medical history of intermittent claudication and hypertension. He is an overweight smoker and heavy drinker of alcohol. On analysing the electrocardiogram (ECG), you notice broad S-waves in the right-hand chest leads, two R-waves per complex in the left-hand chest leads and ST-segment elevation. He asks if he has had a heart attack. What is the best answer to this question?
A 43-year-old man presents to his GP with a 3-month history of recurrent nose bleeds, mucosa! bleeding, haemoptysis and recurrent sinusitis. Besides that, he also noticed that he has increasingly become short of breath. On examination, he had a nasal deformity and chest auscultation revealed crackles in the left lower zone. A urine dipstick test showed microscopic haematuria. Which of the following is the most likely diagnosis?
You are asked to review an electrocardiogram (ECG) in the emergency department. Helpfully, a summary of details is printed at the top as follows: rate 88/min, regular rhythm, axis -20°, PR duration 0.26 seconds (constant), QRS complex 0.08 seconds, QT interval 0.2 seconds. You note that P-waves are only present before each QRS and that the rhythm is regular. Which of the following would be the best s11mmary?
A 44-year-old woman presents to the emergency department with pain. The pain is epigastric, sharp in nature, worse on lying flat and during inspiration. She has recently suffered a chest infection. She is not a smoker. On examination, she has diffuse inspiratory crepitations. Her oxygen saturation is 98% on room air. Her ECG shows widespread saddle-shaped ST elevation. Which of the following is the most likely diagnosis?
A 74-year-old male ex-comedian can no longer perform at smoky open- microphone nights due to shortness of breath. He is coughing up frothy white sputum, which recently has contained a small amount of blood. On examination, his chest demonstrates diffuse crackles on inspiration through which you can just discern a mid-diastolic murmur and a loud first heart sound. His chest X-ray confirms pulmonary oedema. What is the most likely underlying cause for his symptoms?
A 23-year-old woman comes to see you about her stools, which over the last couple of months have become extremely foul smelling, pale in colour and difficult to flush. This has been associated with vague abdominal pains and a bloating sensation. She has found this very embarrassing as she lives in a shared house. She is normally fit and well. What is the most likely diagnosis?
A 40-year-old woman comes to your clinic alone wanting an effective form of contraception. She has two children from a previous marriage and has recently started a new relationship. She says that she does not want any further children. She has regular heavy periods, no menopausal symptoms and she is otherwise well with no past medical history. A recent ultrasound showed a normal sized uterus and pipelle biopsy revealed normal secretory endometrial tissue. What is the most appropriate form of contraception?
A woman is undergoing surgery to enhance the cosmetic appearance of her labia. A bleeding vessel is encountered at the labia majora which cannot be controlled through pressure alone. The surgeon believes it to be a branch of the posterior labial artery. The posterior labial artery is a branch of which artery?
A 54-year-old woman with a history of significant ischaemic heart disease undergoes vaginal hysterectomy for symptomatic uterine prolapse. She develops significant surgical site bleeding which is repaired at reoperation the same day. Her postoperative haemoglobin is 6.4 g/dL. Later the same day she develops chest pain. Her observations, blood gas and cardiac enzymes are within normal limits. An electrocardiogram (ECG) shows sinus rhythm without ST changes. She is charted for thromboprophylaxis. What is the most likely cause of the chest pain?
480 A 60-year-old woman is undergoing abdominal hysterectomy for a fibroid uterus. During suture ligation of the right uterine pedicle, iatrogenic injury to the ureter is confirmed. Which of the following statements is correct?
A 70-year-old man presents to bis GP having noticed a slowly enlarging 'spot' on bis left cheek. On examination, there is a well-circumscribed, skin-coloured nodular lesion on the left cheek with some overlying small blood vessels visible. The most likely diagnosis of this lesion is: