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3,531 questions
A 14-year-old girl presents to her health care provider informing him that she has missed two periods and that she has a pregnancy test confirming that she is pregnant. She has a boyfriend who is 15 and has been having protected sex with condoms for six months. She wants a termination but does not want to involve her parents at all. She is counselled regarding abortion and what it entails and is also asked to involve her parents, but she flatly refuses, indicating that she will otherwise get an abortion elsewhere. She understands the risks of having an abortion. What is the most appropriate action for this patient?
A 27-year-old female presents with a three hour history of vaginal bleeding, abdominal pain and right shoulder tip pain. Her past history includes pelvic inflammatory disease (PID), a miscarriage and two terminations. A urine pregnancy test is positive. From the following, which is the most appropriate next step of management?
A 22-year-old nulliparous female, who is not sexually active, seeks treatment for menorrhagia and primary dysmenorrhoea, but she does not want a contraceptive treatment. Which of the following is the most appropriate choice, initially?
A 36-year-old overweight woman presents with irregular heavy bleeding. Her endometrial biopsy reveals cystic hyperplasia but no atypia. Which of the following would be the most appropriate treatment for this woman?
A 35-year-old female presents with menorrhagia that has not responded to treatment with non-steroidal anti-inflammatory drugs. One year ago she underwent sterilisation. Which of the following would be the most appropriate treatment for her?
A 25-year-old woman is admitted on the medical intak She is 10 weeks post-partum and has been generally unwell for two weeks with malaise sweats and anxiety. On examination she is haemodynamically stable, and clinically euthyroid. TFTs show the following: Free T4: 33pmol/L (9-23); Free T3: 8 nmol/L (3.5-6); TSH <0.02mU/L (0.5-5). What is the appropriate management?
A 48-year-old woman has been diagnosed with essential hypertension and was commenced on treatment three months ago. She presents to you with a dry cough which has not been getting better despite taking cough linctus and antibiotics. You assess the patient's medication history. Which of the following antihypertensive medications is responsible for the patient's symptoms?
A 16-year-old boy is diagnosed with a small ventricular septal defect, having been screened by echocardiography because of a family history of hypertrophic obstructive cardiomyopathy. He is entirely asymptomatic, plays several sports regularly and bas no growth retardation. The echocardiogram also confirms a small left to right shunt, with pulmonary to systemic flow ratio only just above one. Which of the following is the most likely to be a significant complication of his condition?
A 56-year-old man presents to the accident and emergency department with a 2-hour history of central chest pain radiating to the left arm. He is anxious, nauseated and sweaty. His pulse rate is 120/minute in sinus rhythm and the ECG reveals ST elevation in leads II, ID and aVF. The troponin level is significantly raised. This is certainly acute MI. Which is the most likely coronary vessel to be occluded?
A 45-year-old woman complains of increasing shortness of breath on exertion, as well as orthopnoea, for the previous 3-4 months. She had apparently recovered from pericarditis about a year earlier. On ECG there is low voltage, especially in the limb leads, and the chest x-ray shows pericardia} calcification. The presumptive diagnosis is constrictive pericarditis. Which of the following physical signs would be consistent with this?
A 71-year-old man is being treated for congestive heart failure with a combination of drugs. He complains of nausea and anorexia, and has been puzzled by observing yellow rings around lights. His pulse rate is 53/minute and irregular and blood pressure is 128/61 mmHg. Which of the foilowing medications is likely to be responsible for these symptoms?
An asymptomatic 31-year-old woman has been referred for cardiological assessment. After her ECG she was told that she had mitral valve prolapse and would like further information on this condition. Which of the following statements is correct?
You see a 46-year-old woman on your ward who has been diagnosed with bron.chiectasis following a three-month history of a mucopurulent cough. Which of the following from the list below is not a cause of bronchiectasis?
A 67-year-old man presents with dyspnoea and fatigue with signs of a raised jugular venous pressure (JVP), hepatomegaly and peripheral oedema. The patient has a longstanding history of COPD. You suspect cor pulmonale. Which of the following is not a cause of cor pulmonale?
A 25-year-old woman is admitted to accident and emergency with a severe exacerbation of asthma. On examination, her respiratory rate is 30, oxygen saturations are 95 per cent on 15 L USMLE IM2e/Basic 02 and temperature is 37.2°C. As you feel the peripheral pulse, the volume falls as the patient inspires. Which of the following explains this clinical sign?
You see a 67-year-old man who has presented with a four-month history of progressive shortness of breath, initially on exertion but now also at rest. Associated symptoms include a dry cough. His past medical history includes atrial fibrillation, hypertension and hypercholesterolaemia. On examination, oxygen satura.tions are 92 per cent on room air, respiratory rate is 19 and the patient is apyrexiaJ. On auscultation of the chest you hear bibasal fine inspiratory crackles. You review the patient's medication history. Which of the following drugs from the patient's list is most likely to cause the symptoms experienced by the patient?
A 44-year-old plumber has a 4-day history of fever and generalized myalgia. Two days ago he developed a dry cough coupled with mild dyspnoea and has been feeling very lethargic. On examination his temperature is 38.5°C, respiratory rate 20, oxygen saturations ranging between 93 and 96 per cent on room air and auscultation of the chest reveals bibasal crackles. Bloods show a raised white cell count of 18.2 and neutrophil count of 11.0, CRP of 90 and a raised ALT of 261 and ALP 96. Chest x-ray reveals bibasal consolidation. The patient is treated with antibiotics for bibasal pneumonia. From the list below, select the most likely organism responsible for the pneumonia:
A 58-year-old man is admitted with a mild exacerbation of asthma. He suffers with hypertension which is controlled with medication. He was given 5 mg salbutamol and 500 µg ipratropium nebulizers, on route to hospital, by paramedics and has received 'back to back' salbutamol 5 mg nebulizers since admission to accident and emergency. The patient was then sent to the acute medical unit where he was given regular nebulizers along with his regular antihypertension medication. Before he was discharged, his serum potassium reading was 2.9. Select, from the list below, the drug which is most likely to have caused the hypokalaemia?
A 45-year-old man with diabetes, diagnosed with pulmonary TB who started treatment two months ago, presents to you with a week's history of pins and needles in his hands and feet with associated numbness. He tells you that his symptoms started since he stopped taking the vitamins given to him at the start of his TB treatment. From the list below, which of the foilowing drugs is responsible for the symptoms described by the patient?
A 47-year-old woman presents to your clinic with a three-month history of dysphagia. There is no history of drastic weight loss and the patient experiences symptoms when swallowing solids but not liquids. Which of the following is not an obstructive cause of dysphagia?