Medical
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3,531 questions
A 29-year-old woman is referred to a diabetic clinic for poor diabetes management. She was diagnosed with type 1 diabetes at the age of 12 and prescribed actrapid insulin injections. USMLE IM2e/Diagnostic Recently, the patient has been suffering fluctuations in her plasma glucose levels and her previously well-controlled glycated haemoglobin has risen to 8.1 per cent. The patient admits she has recently been avoiding using her injections. On examination, the patient has a raised, smooth lump that is firm on palpation at the lower abdomen. The most likely diagnosis is:
A 7-year-old girl presents with red striae which her mother noticed around her abdomen. The girl also has plethoric cheeks and, on her back, several faint, irregular brown macules are observed. The mother is particularly concerned about the early breast development that seems apparent on her daughter. Serum phosphate is decreased. The most likely diagnosis is:
An 18-year-old man presents to clinic worried about his scant pubic hair development. Examination reveals undescended testes and plasma testosterone, luteinizing hormone and follicle stimulating hormone were found to be low. A karytotype test was 46, XY. The patient was otherwise well, but during neurological examination struggled during the olfactory test. The most likely diagnosis is:
A 15-year-old girl complains of headaches which started 6 weeks ago. The headaches initially occurred 1-2 times a week but now occur up to five times a week, they are not associated with any neurological problems, visual disturbances, nausea or vomiting. The girl also reports a white discharge from both of her nipples. She has not started menstruating. The most appropriate investigation is:
A 47-year-old woman is referred to the endocrine clinic complaining of a two- month history of tiredness. Despite wearing several items of clothing, the patient appears intolerant to the room temperature. She has noticed an increase in weight, particularly around her waist. The most appropriate investigation is:
A 58-year-old woman presents with an acutely painful neck, the patient has a fever, blood pressure is 135/85 mrnHg and heart rate 102 bpm. The patient explains the pain started 2 weeks ago and has gradually become worse. She also notes palpitations particularly and believes she has lost weight. The symptoms subside and the patient presents again complaining of intolerance to the cold temperatures. The most likely diagnosis is:
A 6-year-old girl presents to accident and emergency with severe abdominal pain, nausea and vomiting. On examination, the patient is tachypnoeic, capillary refill is 3 seconds and she has a dry tongue. While listening to the patient's lungs, you detect a sweet odour from her breath. The most likely diagnosis is:
A 45-year-old Asian man is diagnosed with Cushing's disease in India. He 11ndergoes a bilateral adrenalectomy and recovers well from the operation. On his return to the UK one year later, he complains of a constant dull headache, peripheral visual disturbances and increasing pigmentation of the skin creases of both hands. The most likely diagnosis is:
A 29-year-old woman is found unconscious by her partner and rushed to accident and emergency. She is a type 1 diabetic and has maintained excellent glucose control using insulin USMLE IM2e/Diagnostic injections. Blood biochemistry results demonstrate a moderately raised level of insulin, no detectable C-peptide and very low blood glucose. Her partner mentions she is a lawyer and has been working particularly hard in the last week, eating quick meals and occasionally missing meals. The most likely diagnosis is:
A 37-year-old man presents with symptoms of an acute headache, vomiting, malaise and visual disturbance. A neurological examination reveals a bitemporal superior quadrantanopia. A CT scan shows a hyperdense area within the pituitary gland. The most likely diagnosis is:
A 38-year-old woman presents to clinic complaining of changes in her appearance and weight gain. She has recently been through a divorce and attributed her weight gain to this. However, despite going to the gym her clothes are still tight, especially around her waist, her face seems puffy and flushed. The most likely diagnosis is:
A 60-year-old diabetic man recovering from sepsis after collapsing at home was treated with appropriate antibiotics after blood culture and aggressive fluid management with 0.9 per cent saline for 2 days for hypotension. Although blood pressure returned to normal, the patient had the following abnormal biochemical blood results: pH 7.32, PC02 5.2, P0211.1, Sodium 147 mmol/L, Potassium 3.5 mmol/L, Chloride 119 mmol/L, Bicarbonate 19.5. The most likely diagnosis is:
A 57-year-old woman, who has recently returned from a holiday in America, presents with dull grey-brown patches in her mouth and the palms of her hand which she has noticed in the last USMLE IM2e/Diagnostic week. She has also noticed she gets very dizzy when rising from a seated position and is continually afraid of fainting. The most likely diagnosis is:
A 36-year-old woman presents to the rheumatology outpatient clinic with a two-month history of stiff hands and wrists. She mentions that the pain is particularly bad for the first few hours after waking up and is affecting her work as a dentist. On examination, the wrists, metacarpophalangeal joints and proximal interphalangeal joints are swollen and warm. What is the most likely diagnosis?
A 55-year-old man presents to his GP with a 2-week history of pain in his hands. The pain is particularly bad in his right hand. On examination, brown discoloration of the nails with onycholysis is noted and the distal interphalangeal joints are tender on palpation. What is the most likely diagnosis?
A 75-year-old woman presents to accident and emergency complaining of pain in her knees. She mentions that this has been troubling her for several months. Pain is generally worse in the evenings and after walking. On examination, there are palpable bony swellings on the distal interphalangeal joints of the fingers on both hands. In addition, there is reduced range of movement and crepitus in the knees. What is the most likely diagnosis?
A 30-year-old man presents to his GP with a 1-week history of painful, swollen knees and a painful right heel. Further history reveals that he has been experiencing burning pains while USMLE IM2e/Diagnostic urinating for the past 2 weeks and that his eyes have become red and itchy. What is the most likely diagnosis?
A 70-year-old woman presents to accident and emergency with sudden onset pain and swelling in the right knee. Her past medical history includes hypertension and hypercholesterolaemia. She is currently taking aspirin, ramipril and simvastatin. On examination, she is apyrexial and the right knee is swollen. There is reduced range of movement in the knee due to swelling and pain. X-ray of the right knee shows chondrocalcinosis. What is the most likely diagnosis?
A 70-year-old woman presents to her GP complaining of severe unilateral headache over the left side of her head. On further questioning, she mentions that she has been having bilateral shoulder and neck pains over the past few weeks. She has also been feeling lethargic. On examination, the left side of her scalp is painful to touch. What is the most likely diagnosis?
A 60-year-old woman presents to her GP with a two-month history of lethargy and weakness. She mentions that she is fmding it increasingly difficult to climll the stairs and do the housework. On examination, there is wasting and weakness of the proximal muscles in the upper and lower limbs. What is the most likely diagnosis?