INTERNAL MED.( DIAGNOSTIC) 1-100

A 60-year-old man presents to accident and emergency with a 3-day history of increasingly severe chest pain. The patient describes the pain as a sharp, tearing pain starting in the centre of his chest and radiating straight through to his back between his shoulder blades. The patient looks in pain but there is no pallor, heart rate is 95, respiratory rate is 20, temperature 37°C and blood pressure is 155/95 mmHg. The most likely diagnosis is

A 67-year-old woman is admitted to accident and emergency with pyrexia (38.1°e) and a cough productive of green sputum. The observations show a pulse rate of 101, BP 80/60 and respiratory rate of 32. She is alert and orientated in space and time. Blood results reveal a wee of 21, urea of 8.5 and chest x-ray shows a patch of consolidation in the lower zone of the right lung. She is treated for severe community-acquired pneumonia. Which of the following is the correct calculated eURB-65 score?

A 45-year-old woman with unexpected weight loss, loss of appetite and shortness of breath presents to you in clinic. On examination, there is reduced air entry and dullness to percussion in the right lung. A pleural tap is performed and the aspirate samples sent for analysis. You are told that the results reveal a protein content of>30 g/L. From the list below, select the most likely diagnosis:

You see a 28-year-old man, with no past medical history, in accident and emergency who developed an acute onset of pleuritic chest pain and shortness of breath while playing football. On examination, oxygen saturations are 93 per cent on room air, respiratory rate 20 and temperature is 37.1°C. There is decreased expansion of the chest on the left side, hyper-resonant to percussion and reduced air entry on the left. The most likely diagnosis is:

A 56-year-old man attends your clinic with a three-month history of a productive cough with blood-tinged sputum, following his return from India. Associated symptoms include lethargy, night sweats and decreased appetite. He is normally ft and healthy with no past medical history. On examination, the patient's chest has good air entry bilaterally with no added sounds and his temperature is 37.3°C. A sputum sample sent from the patient's GP reveals a growth of acid fast bacilli. From the list below, which is the most likely diagnosis?

You see a 25-year-old woman who presents with a 24-hour history of watery diarrhoea. She states that she has opened her bowels 11 times since her onset of symptoms. Associated symptoms include nausea and vomiting with abdominal cramps and pain which started in the evening following a barbeque meal in the afternoon that day. The patient is alert and orientated and her observations include a pulse rate of 69, blood pressure of 124/75 and temperature of 37.1°C. On examination, her abdomen is soft, there is marked tenderness in the epigastric region and bowel sounds are hyperactive. The patient is normally fit and well with no past medical history. The most likely diagnosis is:

You see a 54-year-old woman, referred to accident and emergency through her GP, with a week's history of jaundice and right upper quadrant abdominal pain. Associated symptoms include dark urine and pale stools. There is no history of weight loss and the patient does not consume alcohol. Her liver function tests reveal a bilirubin of 40 µmol/L, ALT of 40 iu/L, AST 50 iu/L and ALP of 350 iu/L. The most likely diagnosis is:

A 66-year-old woman with poorly controlled type 2 diabetes presents to accident and emergency with a 2-day history of severe pain in the right flank, nausea and fevers that come and go. On examination, the patient appears unwell, sweaty and has visible rigors with a temperature of 38°C. The patient denies any recent travel. Urine dipstick is positive for protein, blood, leukocytes and nitrates. A CT scan of the abdomen reveals gas in the renal parenchyma area. The most likely diagnosis is:

A 55-year-old man complains of a 4-week history of general malaise and fatigue, he has also noticed his trousers have become more loose fitting. A blood test shows the following results: Haemoglobin 12 g/dL, MCV 90 f, Platelet count 250 x 109/L, WBC 10 x 109/L, Serum iron 10 µmoVL, Total iron-binding capacity 40 µmoVL, Serum ferritin 160 µg/L. The most likely diagnosis is:

A 45-year-old man collapses at home and is brought to accident and emergency. He has a fever at 39.5°C and blood pressure is 90/60 mmHg, although he is in a lucid state. Bruises can be seen on his skin which he remembers being present before he fell. Blood tests show the patient to have a normocytic anaemia with a low platelet count and increased fibrin split products. The most likely diagnosis is:

A 65-year-old woman suffers significant bleeding during a difficult bowel resection and is prescribed three units of blood after the operation is completed. It is the frst time she has required a blood transfusion and her details are checked carefully. Approximately 4 hours after the transfusion the patient feels acutely unwell and complains of fever, chills and a dry cough. Blood pressure is 110/80 mmHg, temperature 38°C and oxygen saturation is 94 per cent. The most likely diagnosis is:

A 52-year-old woman presents complaining of a two-month history of increasing fatigue and numbness in both of her arms and legs. She lives at home with her husband and has found it diffcult coping with the daily activities of living. She suffers from hypothyroidism which is well controlled with thyroid replacement medication. A peripheral blood smear shows hypersegmented neutrophils. A blood test reveals the following: Haemoglobin 10 g/dL, Mean corpuscular volume 110 f, Platelets 150 x 109/L. Liver function tests: ALT 25 IU/L, AST 27 IU/L, GGT 22 IU/L, ALP 100 IU/L, Urea 5 mmol/L, Creatinine 100 µmol/L. The most likely diagnosis is: