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3,531 questions
A 51-year-old man complains of severe, diffuse back pain. An x-ray finds several lytic lesions in the vertebra alongside hypercalcaemia. Bence-Jones protein is detected in the urine. What is a Bence-Jones protein?
A 19-year-old woman collapses at a concert and is witnessed to have a tonic-clonic seizure lasting 2 minutes. When the paramedics arrive and ask her questions, she mumbles but no-one can understand what she is saying. Only when the paramedic applies pressure to her nailbed does she open her eyes and reach out with her other hand to rub her nail and then push him away. What is her Glasgow Coma Scale (GCS)?
A 42-year-old woman presents with ataxia. Gadolinium-enhanced MRI reveals multiple subcortical white matter lesions as well as enhancing lesions in the cerrebellum and spinal cord. She is diagnosed with MS. Two months later she develops optic neuritis. What feature is associated with a milder disease course?
A left-handed 79-year-old man presents with a troublesome resting tremor of his left hand. The tremor is evident in his writing. He has also noticed his writing is smaller than it used to be. He complains he has difficulty turning in bed to get comfortable and his wife complains that he sometimes kicks her in the middle of the night. When he gets out of bed in the morning he feels a little woozy, but this resolves after a while. On examination, he blinks about three times a minute and his face does not show much emotion. Glabelar tap is positive. He has a slow, shuffling gait. He has difficulty stopping, starting and turning. He holds his feet slightly apart to steady himself. When you pull him backwards, he is unable to right himself and stumbles back. Which of the signs and symptoms is not commonly associated with parkinsonism?
A 23-year-old woman is seen in clinic for recurrent funny turns. She is not aware of them, but her family and friends have noticed them. They say she looks around blankly, then starts picking at her clothes and sometimes yawns, then she comes back after a minute. She can get drowsy after these episodes. What seizure type does this patient describe?
You are asked to perform a lower limb peripheral neurological examination on a 45-year-old diabetic male. The patient has normal tone, 5/5 power, normal plantars and proprioception. However, you notice that the patient does not respond to any sensory stimulus on the medial side of the right lower leg. Which dermatome is affected?
A 55-year-old woman complains of double vision. She finds that she is more tired than usual and has difficulty climbing stairs, especially when they are very long. She has difficulty getting items off high shelves at work and lately even brushing her hair is a problem. During the consultation, her voice fades away during conversation. Reflexes are present and equal throughout. Which sign or symptom is most indicative of myastbenia gravis?
A patient has difficulty walking. His gait is unsteady. He seems to have difficulty raising his right leg and swings it round in an arc as be walks. He holds his right arm and wrist flexed. What type of gait does this patient exhibit?
A 40-year-old woman seen in clinic has multiple fleshy nodules and several light brown, round macules with a smooth border on her back, arms and legs. There are also freckles under her arms. What is the underlying disorder?
A 74-year-old man with T2NOMO squamous cell carcinoma of the tongue is currently undergoing hyper-fractionated radiotherapy with curative intent. He has had no previous surgery. This type of therapy is best described by which of the following terms:
A 62-year-old electrician has presented to accident and emergency with a sudden decline in his exercise tolerance. He mentions that he can only walk 5 yards and that he has had a persistent cough with some haemoptysis over the previous month. A chest x-ray confirms a right-sided pleural effusion, which is then drained. A repeat x-ray shows a round shadow in the right perihilar region. Subsequent bronchoscopy and biopsy confirms small cell carcinoma. Which of the foilowing statements is most true about small cell carcinomas of the lung?
A 24-year-old woman in her first pregnancy presents to the labour ward in labour. She and her partner express an overwhelming desire to avoid a caesarean section. Her labour does not progress and after 9 hours her cervix is stiJJ only 3 cm dilate Unfortunately, the fetal heart slows to 60 beats and does not recover after 5 minutes. Your senior registrar explains the situation to the woman and recommends an immediate caesarean section. She refuses and her partner tells you to stop harassing them. You explain that their unborn child will die if this continues. What options do you have?
A 68-year-old man presents to his GP complaining of increasing shortness of breath. He has noticed deterioration in his exercise tolerance, particularly while mowing the lawn. He has a past history of squamous cell carcinoma of the lung for which he finished radiotherapy treatment a year ago. On examination, there are fine inspiratory crackles in the right lung base. The most likely cause of his shortness of breath is:
A 39-year-old woman has undergone a wide local excision for a 0.5 cm ductal carcinoma of her right breast. Sentinal node biopsy, histology and staging scans have confirmed the disease as TlNOMO. Histology has confirmed the cancer as oestrogen and progesterone receptor positive. Which of the following statements is most accurate regarding this female's treatment options?
A 55-year-old woman with metastatic pancreatic cancer attends the oncology clinic prior to her second cycle of chemotherapy. She tolerated her first cycle well but her husband mentions that there have been occasions where she has been confused. Her urea and electrolyte blood tests reveal a serum sodium of 116 mmol/L. All other results were within the normal range. The chemotherapy is delayed and a urine specimen is sent off. This reveals a urine osmolality of 620 mmol/kg. The most likely cause of the hyponatraemia is:
A 65-year-old woman who is currently receiving chemotherapy for acute myeloid leukaemia is found on blood testing to have urea of 10.1 mmol/L, creatinine of 190 mol/L, potassium of 6.1 mmol/L, phosphate of 8.5 mg/d.L and corrected calci11m of 2.00 mmol/L. The patient is asymptomatic. Her electrolyte levels were normal prior to the start of treatment. What is the most likely cause of this electrolyte disturbance?
A 12-year-old boy who has been suffering from atopic dermatitis for the last ten years presents to you with a 3-day history of severe itching and pus discharge from his left elbow. On examination, you observe lichenification of his left elbow with superimposed excoriations which are weeping a viscous yellow fluid. You take a swab of this discharge. Which one of the following organism growths would you likely expect to be isolated from the swab?
A 67-year-old woman presents to you with extensive scalp hair loss which has been getting progressively worse over the last year. You also notice thinning of the eyebrows. The patient's past medical history includes hypertension, left-sided pulmonary embolism one year ago and hypercholesterolaemia. You assess the patient's medication list. Which one of the following drugs could be responsible for causing generalized alopecia?
A quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change. This is an accepted definition of what?
A 56-year-old man presents in your clinic with a three-month history of weight loss despite no change in his appetite. The patient has no past medical history and no known drug allergies. On examination, you notice an area of hyperpigmented skin in his left axilla. On palpation, the texture of the area of hyperpigmentation feels velvety. You suspect that the patient has acanthosis nigricans secondary to a possible malignancy. Which one of the following malignancies is most commonly associated with this dermatological presentation?