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3,531 questions
Erythroderma is described as a chronic inflammatory skin condition characterized by scaling affecting greater than 50 per cent of the total body. Which one of the following cutaneous malignancies would you expect erythroderma to be associated with?
A 55-year-old man who has been smoking 20 cigarettes a day for the last 30 years has been diagnosed with a right-sided pleural effusion following admission with a week's history of shortness of breath. From the list below, select the most likely findings that one would ascertain during examination of the chest wall:
A 39-year-old woman is seen in the gynaecology clinic having been diagnosed with polycystic ovarian syndrome (PCOS). She has lots of questions in particular about the associated long-term risks. Which of the following is not a risk of PCOS?
A 23-year-old woman is brought into accident and emergency after collapsing at her office. She admits having been stressed and had stayed up all night preparing for a presentation she gave this morning. She describes sitting at her desk and seeing multicoloured circles of light in her right visual field then waking in the ambulance with an oxygen mask on. She feels tired, achy and confused. Her colleague who witnessed the event tells of his fright as he saw her collapse and start jerking both arms and legs. What best describes her seizure?
You are asked to examine a 16-year-old boy with suspected Marfans' syndrome. The patient is tall and thin limbed with long slender fingers, you notice a pectus excavatum of the chest and on examination of the mouth a high arched palate is visible. Which of the following is not included in the cardiovascular criteria for Marfans?
An 88-year-old woman who lives in a nursing home has a past medical history of hypertension, diabetes and ischaemic stroke resulting in left-sided hemiplegia. She suffers from frequent urinary tract infections. Her drug history includes aspirin, simvastatin, insulin and lisinopril. She presents with an ulcer on her left heel. Her HbAlc = 6.1 per cent. Her BM is 8.9, blood pressure is 112/87, heart rate 62. She seems comfortable at rest. Her lungs are clear and her abdomen is soft and non- tender. There is a 2 x 2 cm ulcer on her left heel. Her right foot is normal. What is the most likely cause of her ulcer?
A four-year-old girl presents to her GP, with her mother, with a 2-day history of fevers and diarrhoea. Her mother has contacted her nursery, who have informed her that several of the USMLE IM2e/Basic other children have been off sick with the same problem. What is the most likely causative organism?
A 21-year-old man presents to accident and emergency with a hot, swollen, painful right knee and feeling generally unwell. On examination, his temperature is 38.5°C and he is unable to weight bear. He cannot move his right knee joint due to the pain. A diagnosis of septic arthritis is suspected and the joint is aspirated. What organism is most likely to be seen on the Gram stain of the joint aspirate?
A 29-year-old man presents to the emergency department with a I-week history of non-productive cough, muscle aches, fever, vomiting and diarrhoea. His observations include temperature 38.4°C, pulse rate 105 bpm, blood pressure 110/76 mmHg and respiratory rate 22/min. On examination, his chest is clear to both auscultation and percussion. A chest X-ray shows bilateral lung basal infiltrates. The blood results show Na+ 128 mmol/L, K+ 4.0 mmol/L, urea 5.9 mmol/L, creatinine 130 mmol/L, albumin 26 g/L, ALT 106 IU/L, ALP 230 IU/L. What is the most likely causative organism?
You are reviewing the medication of a 62-year-old man suffering from depression and cardiac arrhythmias. He was recently discharged from hospital for chest pain. During his admission, he was noted to have ''torsades de pointes''. What is torsades de pointes?
A 40-year-old man presents to the emergency department after 8 hours of a severe frontal headache, photophobia and two episodes of vomiting. On examination his Glasgow Coma Score USMLE IM2e/Basic (GCS) is 13 (eyes open to voice, verbal response with confused sentences, and moving freely), he has a temperature of 38.5°C, a BP of 95/65 mmHg and pulse rate of 105 bpm. He is photophobic and has neck stiffness. There is no rash and no focal neurological deficit as far as you can ascertain. His wife is present and is able to elaborate on the history. He has hit the bottle quite hard since losing his job 7 months ago and has been drinking 8-10 cans of lager per night. He has recently been coughing a lot and feeling unwell. He still lives at home and has not appeared to lose weight recently. What are you most concerned that this might be?
A 24-year-old man presents with two episodes of involuntary clonic beating of the right arm followed by loss of consciousness with urinary and faecal incontinence. He then had a headache and confusion for some hours (no- one witnessed any episode). A diagnosis of motor partial seizures with secondary generalisation is made. He is started on valproate. Which of the following would you NOT tell him (as it is untrue)?
A 65-year-old woman presents to her GP complaining of tiredness, shortness of breath and loss of sensation in her feet. On examination she is visibly pale, has mild ja1indice and glossitis. She has loss of joint position sense and vibration distally, with extensor plantar reflexes, absent ankle jerks and brisk knee jerks bilaterally. What is the most likely cause for her symptoms?
A 30-year-old-man presents to the outpatient clinic with a 2-month history of progressive effort intolerance. Some three weeks ago he experienced an episode of shortness of breath at rest, suggestive of paroxysmal nocturnal dyspnoea. Examination reveals a JVP raised up to his earlobes, a soft tender hepatomegaly and a bilateral pitting oedema up to his knees. Chest examination reveals bibasal crepitations, and an audible S3 on auscultation of the heart. The cl1est X-ray shows cardiomegaly with interstitial infiltrates. Echocardiography shows global left ventricular hypokinesia with an ejection fraction of 25-30%. Which of the following is the LEAST likely aetiological factor?
A 32-year-old-woman was cross-country skiing when she fell down a water-filled gully and became trapped beneath an ice-sheet. Frantic efforts were made to extract her, but after 40 minutes all movements ceased. Which of the following statements is true?
A 54-year-old man suddenly develops weakness of the left side of his face and arm and difficulty in.speech. This episode lasts for 15 minutes. He has a history of hypertension, which is well controlled on a calcium channel blocking agent. His brother had had a severe disabling stroke at the age of 50. Cholesterol level is 5.8mmol/l. CT scan performed the same day shows the presence of 2 old lacunar strokes in the right middle cerebral artery territory. CT angiogram of the carotid system shows a 60o/o stenosis of the right internal carotid artery. Which of the following factors is the strongest predictor of his being at a high risk of early recurrent stroke?
A 72-year-old Caucasian man is referred to out-patients with a 6-month history of progressive exertional dyspnoea. His ankles swell as the day progresses. There is no associated chest discomfort. He is an ex-smoker of 3 years and drinks 12 pints of beer per week. He has not seen his GP in the previous 15 years. The only past history is that of mild asthma as a child. His father died of a myocardial infarct aged 65 years. Blood pressure is 150/86 mmHg. Results of investigations are as follows: renal function, normal; cholesterol, 6.8 mmol/1; ECG, sinus rhythm LBBB; echo, dilated and impaired left ventricular function with ejection fraction of 30o/o, mild to moderate mitral regurgitation, no LVH. What is the most likely underlying aetiology?
A 70-year-old woman is admitted to hospital with a swollen left leg 4 weeks after undergoing an elective total hip replacement. An above-knee DVT is diagnosed by ultrasound. She is in sinus rhythm at 60 bpm and her blood pressure is 160/80 mmHg. She is commenced on the appropriate dose of low molecular weight heparin and warfarin loading. The following day she becomes acutely short of breath. Examination reveals a resting tachycardia (110 bpm) with blood pressure of 100/60 mmHg. Her JVP is elevated at 7 cm above the sternal notch. Arterial blood gas measurement reveals her to be hypoxaemic with a pa(02 ) of 7 mmHg. What would be the first-line therapy after administering high-flow oxygen?
A 30-year-old woman presents with a three month history of chest pain. On auscultation, there is a midsystolic click and a late systolic murmur. Her electrocardiogram shows T-wave inversions in leads II, ID, and aVF. Which of the following statements concerning her condition is true?
A patient who has been inadvertently given an intravenous injection of potassium chloride, develops ventricular tachycardia. His pulse is 150 beats per minute and blood pressure 60/40 mmHg. What would be the best line of treatment in this case?