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3,531 questions
A 6-year-old has a sore throat and has been given antibiotics. Three weeks later, he represents feeling feverish with nausea, vomiting and tea-coloured urine. Urine dipstick confirms haematuria and protein. Blood pressure is 100/60 mmHg. The most likely diagnosis is:
A 23-year-old woman presents to accident and emergency with a purpuric rash over the buttocks and lower limbs and haematuria. She is finding it difficult to mobilize due to pain in her ankles and knees. What is the most likely diagnosis?
A 19-year-old woman is referred to your early pregnancy unit as she is having some vaginal bleeding. This is her first pregnancy, she has regular menses and the date of her last menstrual period suggests she is 8 weeks gestation today. She is well apart from her bleeding and is naturally concerne A transvaginal ultrasound reveals an intrauterine gestational sac of 18 mm with a yolk sa What is the most likely explanation of these findings?
A 31-year-old woman presents to accident and emergency with progressive difficulty walking associated with lower back pain. A few days ago she was tripping over things, now she has difficulty climbing stairs. She describes tingling and numbness in both hands which moved up to her elbows, she is unable to write. On examination, cranial nerves are intact but there is absent sensation to vibration and pin prick in her upper limbs to the elbow and lower limbs to the hip. Power is 3/5 in the ankles and 4-/5 at the hip with absent reflexes and mute plantars. Her blood pressure is 124/85, pulse 68 and sats 98 per cent on air. She has a past medical history of type I diabetes and recently recovered from an episode of food poisoning a month or two ago. What is the diagnosis?
A mother comes to labour ward who is low risk, in labour at term. The unit is short staffed and there are not enough midwives to provide intermittent auscultation of the fetal heart. You decide to start continuous electronic monitoring (CTG). She is an epidemiologist and asks you about the CTG and how it will help her labour and prevent her baby suffering harm. Which of the following would you tell her? Continuous monitoring has a?
In clinic, a retired 62-year-old man presents with shortness of breath on exertion. You find a collapsing pulse and subsequent echocardiography confirms aortic regurgitation. Which of the following is NOT associated with aortic regurgitation?
A 21-year-old woman attends the labour ward with per vaginal bleeding of 100 mL. She is 32 weeks pregnant and has had one normal delivery in the past. An important history to note is that of an antepartum haemorrhage in her last pregnancy and she smokes 10 cigarettes a day. Her 20-week anomaly ultrasound revealed a posterior fundal placenta. She admits she and her partner had intercourse last night and is concerned by terrible abdominal pains. What is the most likely diagnosis?
A 38-year-old woman in her first pregnancy is 36 weeks pregnant. She presents to the labour ward feeling dizzy with a mild headache and flashing lights. Her past medical history includes systemic lupus erythematosus (SLE), renal stones and malaria. Her blood pressure is 158/99 mmHg with 2+ protein in her urine. Her platelets are 55 x 109/L, Hb 10.1 g/dL, bilirubin 62 µmol/L, ALT 359 IU/L, urea 2.3 mmol/L and creatinine 64 µmol/L. What is the most likely diagnosis?
A 24-year-old woman who is 32 weeks pregnant presents to the labour ward with a terrible headache that has not improved despite analgesic. It started 2 days ago and came on suddenly. She has stayed in bed as it hurts to be in sunlight and she vomited twice this morning. Her past medical history includes a macroprolactinoma (which has been removed) and occasional migraines. She is haemodynamically stable with no focal neurology or papilledema. You arrange for her to have a CT of her head as an emergency, which adds no further information to aid your diagnosis. There are red cells on lumbar puncture but no organisms are isolate What is the most likely diagnosis?
A 44-year-old women who is 18 weeks pregnant presents to your clinic with a 2-day history of a viral illness. She is extremely anxious and is in floods of tears. She recently had some soft cheese in a restaurant and after an internet search she is convinced she has a particular infection. What infection is she concerned about?
A 26-year-old woman is 37 weeks pregnant and consults you about a rash that started on her abdomen and has now spread all over her body. Interestingly her umbilicus is spare The rash is very itchy and nothing is helping. The rash is her first problem in this pregnancy. Of interest, her mother has pemphigoid and her sister has psoriasis. What is the most likely cause of her rash?
A 42-year-old woman is in her first pregnancy. She conceived with in vitro fertilization (IVF) and has had a straightforward pregnancy so far. At 25 weeks' gestation she is seen in clinic with a blood pressure of 142/94 mmHg and protein + in her urine. A protein creatinine ratio (PCR) comes back as 19. She says that her blood pressure is often up at the doctor's. With the information you have to hand what is the most likely diagnosis?
A 24-year-old woman attends accident and emergency 4 weeks after having a positive urinary pregnancy test. She has had 3 days of painless vaginal bleeding and is passing clots. Over the past 2 days the bleeding has settle. An ultrasound scan shows an empty uterus. What is the correct diagnosis?
An 18-year-old woman presents to accident and emergency having fainted at work. She is complaining of pain in the lower abdomen. A serum beta hCG performed in the emergency department is 3020 mlU/mL. The on-call gynaecologist performs transvaginal ultrasonography in the resuscitation area which shows free fluid in the Pouch of Douglas and no visible intrauterine pregnancy. Her pulse is 120 bpm and blood pressure 90/45 mmHg. What is the most likely diagnosis?
A 26-year-old woman presents to accident and emergency with left-sided lower abdominal pain and a single episode of vaginal spotting the day before. A urinary beta hCG is positive, and her last period was 6 weeks ago. A transvaginal ultrasound shows two gestational sacs. What is the most likely diagnosis?
A 59-year-old woman attends the gynaecology clinic complaining of worsening pain during penetrative sexual intercourse. She went through the menopause 9 years before, with very few problems, and did not require hormone replacement therapy (HRT). She has been with the same partner for 4 years since the death of her husband with whom she had four children. What is the most likely diagnosis?
A 19-year-old woman is referred to accident and emergency with a fluctuant lower right abdominal pain which started over the course of the morning, associated with vomiting. There is rebound tenderness on examination. She is afebrile. Serum beta human chorionic gonadotrophin (hCG) is negative. An ultrasound shows free fluid in the peritoneal cavity but no other pathology to account for the pain. White cells are 14 * 109/L and the C-reative protein (CRP) is 184 mg/L. What is the most likely diagnosis?
A 38-year-old nulliparous woman has had an uncomplicated pregnancy. She has laboured very quickly and is 10 cm dilate The fetal heart falls to 60 for 4 minutes. She is pushing effectively and the head is 1 cm below the ischial spines. You prepare for forceps delivery in the room. She has had no analgesia so you quickly insert a pudendal nerve block and deliver the baby 4 minutes later in good condition. Which of the following is not a branch of the pudendal nerve?
A 39-year-old woman is 6 days post-partum and has come back to hospital with shortness of breath. She is struggling to breath at rest, has a respiratory rate of 28, pulse 115, BP 105/60 mmHg, temperature 37.4 On examination she has an audible wheeze and cough. Investigations reveal a PO2 of 9.5 kPa on arterial blood gas and a PCO2 3.7 kPa, pH 7.36, base excess -3.4. A chest x-ray shows some upper lobe diversion and bilateral diffuse shadowing with an enlarged heart. Her haemoglobin is 8.9 g/dL, white blood count 11.1 x 109/L and C-reactive protein 21 mg/L. What is the most likely cause of her symptoms?
A 17-year-old girl is seen in accident and emergency 14 days after an emergency caesarean delivery of a healthy infant, her first. Her neighbours became concerned and called the polic She had been seen prostrate in the garden chanting verses from the Bible and shouted at them accusing them of being spies when they asked if she was ok. They say her problem has worsened over the past fortnight. What is the most likely diagnosis?