LOL
A 7 year old with a 3-day history of upper respiratory tract infection is brought to accident and emergency by his mother because he suddenly went pale and sweaty and seems to be working hard to breath. The triage nurse calls you to see him urgently because his heart rate is 200 beats per minute. You take him round to the resuscitation area, give him oxygen and connect him to the cardiac monitor. The electrocardiogram (ECG) shows a narrow complex tachycardia with a rate of 180 beats per minute. He remains alert, with a respiratory rate of 40. What is the most appropriate initial diagnosis?
Atrial fibrillation
Wolff–Parkinson–White syndrome
Ventricular fibrillation
Supraventricular tachycardia (SVT)
Ventricular tachycardia
The mother of a 4-year-old otherwise healthy-appearing boy brings him in for evaluation because he had profound generalized body odor (bromhidrosis) for the past several days. Upon careful questioning, the mother recalls an episode of sneezing followed by a 3- to 4-day history of a purulent, blood-tinged nasal discharge. Of the following, the most likely cause of the body odor is
Nasal foreign body
Allergic rhinitis
Pachyonychia congenita
Epidermolytic hyperkeratosis
Premature adrenarche
A 20-month-old boy has been referred due to delayed walking. On further questioning you establish he has no difficulty feeding, had head control at 3 months of age, and sat up by 8 months. He has been crawling for the last 8 months, but he does not pull to stand or walk with support. He has no dysmorphic features. There is no known family history of muscle problems. His mother has no myotonia. His mother is very concerned and asks you what is wrong. What is the most likely diagnosis?
Myasthenia gravis
Becker’s muscular dystrophy
Down’s syndrome
Duchenne’s muscular dystrophy
Myotonic dystrophy
A 4-year-old girl has recently moved to the area and is registering with you, her new GP. She has had a diagnosis of primary ciliary dyskinesia (PCD) made last week and the parents wish to know more about the complications. Which of the following is not a complication of PCD?
Pancreatic insufficiency
Bronchiectasis
Sinusitis
Infertility
Dextrocardia
A 3 year old is brought to accident and emergency by his parents because he has not been walking for the past day and refuses to stand. He is normally fit and healthy but he did have antibiotics for tonsillitis 2 weeks ago. They do not think he has had any injuries but he attends daycare and something could have happened there. He is up to date with his immunizations and his parents have no concerns with his development. On examination he looks well, is apyrexial, with a heart rate of 120 and respiratory rate of 26 with no bruising. His knees are normal on examination and the hips have a full range of movement except he cries on external rotation of the right hip. There are no deformities seen on x-ray of the hips and knees. After some paracetamol he manages to stand and take a few antalgic steps with encouragement, limping on the right leg. What is the most likely diagnosis?
Osteomyelitis
Growing pains
Reactive arthritis
Septic arthritis
Non-accidental injury
A 3-day-old baby is brought to accident and emergency with acute respiratory distress. She is tachypnoeic, tachycardic, cyanosed and her capillary refill is 5 seconds centrally. You note she has a flat nasal bridge, down sloping palpebral fissures and epicanthic folds. On auscultation there is a loud ejection systolic murmur at the left sternal edge. What is the most likely diagnosis?
Coartation of the aorta
Tetralogy of Fallot
VSD
Transposition of the great arteries
Patent ductus arteriosus
A 15-year-old girl comes to accident and emergency complaining of sudden right arm weakness and double vision. Last week she was incontinent of urine twice. She is normally fit and well. On examination she has a left-sided 6th nerve palsy and four out of five power in her right arm. The examination is otherwise unremarkable. An MRI head shows multiple hyperintense, inflammatory, white matter lesions. What is the most likely diagnosis?
Tuberous sclerosis
Multiple sclerosis
Tuberculous meningitis
Neurofibromatosis
Brain metastasis
A pregnant woman attends her booking appointment at the antenatal clinic and has her routine blood tests done. She is now 13 weeks pregnant with her first child and you have a positive result for cytomegalovirus (CMV) IgM. You need to discuss the implications of CMV infection on her unborn child. Which of the following are not features of congenital CMV infection?
Hydrocephalus
Intrauterine growth retardation
Deafness
Congenital cardiac defects
Thrombocytopenia
A 15-year-old boy attends his GP with a week of cough productive of yellow sputum, fever to 39°C and chest pain on the right side of the chest on coughing. There is no history of foreign travel or unwell contacts. On examination there is reduced air entry in the right lower zone with crepitations and bronchial breathing. You diagnose a right-sided chest infection. What is the most likely causative organism?
Staphylococcus aureus
Chlamydophila pneumoniae (Chlamydia pneumoniae)
Mycoplasma pneumoniae
Streptococcus pneumoniae
Mycobacterium tuberculosis
A 2-year-old boy is admitted to the paediatric ward with a swollen, painful left knee. He has been afebrile and has a history of minor trauma to his knee earlier today. His mother is a haemophilia carrier and his father is not affected. You are keen to rule out haemophilia in this child. Which two clotting factors should you test for?
Factor X and XI
Factor V and VI
Factor VII and VIII
Factor VIII and IX
Factor VII and IX
The mother of a 6-month-old girl calls you because the infant has not been feeding well all day and appears pale. You tell her to meet you at the emergency department. Upon arrival, you find an awake, alert, but irritable child who wants to take her bottle but fatigues quickly thereafter. On physical examination, she has no fever, a respiratory rate of 50 breaths/min, heart rate of 250 beats/min, and blood pressure of 80/50 mm Hg. Her oxygen saturation is 98% in room air. Her lungs are clear, with good aeration. Her rapid pulse is palpable in all extremities, and she has a capillary refill time of 2 seconds. You administer oxygen and place the child on a cardiac monitor, which reveals a rapid heart rate with a narrow QRS complex. Of the following, the BEST management plan for this infant is
Oral administration of digoxin
Carotid massage
Electrical cardioversion
Intravenous administration of verapamil
Intravenous administration of adenosine
A 14-month-old girl is brought to the emergency department with a 12-hour history of fever and rash. Her mother became frightened when it was difficult to arouse the girl after her nap. Findings on physical examination include a temperature of 104°F (40°C), a heart rate of 164 beats/min, a respiratory rate of 42 breaths/min, and a blood pressure of 75/45 mm Hg. There are petechiae and purpura (Item Q156A) on the chest, arms, and legs. As you are establishing intravenous access and drawing blood for initial laboratory evaluations, you request an immediate dose of antibiotics. Of the following, the MOST appropriate therapy is
Penicillin
Vancomycin plus ceftriaxone
Vancomycin
Vancomycin plus gentamicin
Ceftriaxone
A 15-year-old girl is rushed to the emergency department after slipping off a diving board and striking her head on cement. On physical examination, her mental status evaluation results are completely normal. She can abduct her upper extremities at the shoulder, but cannot flex or extend her arms and minimally moves her fingers. She cannot move her limp lower extremities. You order emergent magnetic resonance imaging of the brain and spine. Of the following, the MOST important therapy to implement before the patient is sent for imaging is
Mannitol 1 g/kg intravenously
Low-molecular weight heparin 1 mg/kg subcutaneously
Methylprednisolone 30 mg/kg intravenously
Fosphenytoin 18 phenytoin equivalents/kg intravenously
Dexamethasone 1 mg/kg orally
A 3-year-old boy who has myelomeningocele and a history of recurrent urinary tract infections presents with a 1-day history of a temperature to 102ºF (38.9ºC) and cloudy urine. Laboratory test results include a peripheral white blood cell count of 15x103/mcL (15x109/L), with 60% neutrophils, 30% lymphocytes, and 10% monocytes. Urine obtained by catheterization is cloudy; has a strong odor; and is positive for nitrites, leukocyte esterase, and blood. Microscopic analysis shows too numerous- to-count white blood cells and 50 to 100 red blood cells, and gramnegative bacilli are seen on Gram stain. One day later, the urine culture is positive for Pseudomonas aeruginosa. Of the following, the MOST appropriate antibiotic for treatment of this patient is
Ceftazidime
Cefuroxime
Vancomycin
Trimethoprim-sulfamethoxazole
Ampicillin
A mother brings her 10-month-old son to the emergency department because he has been vomiting for the past 10 days. The child has not experienced any diarrhea. On physical examination, he is lethargic and has dry mucous membranes, reduced tears, a full anterior fontanelle, and 2-second capillary refill. After a second intravenous bolus of 20 mL/kg of normal saline, the boy extends his arms and legs forcefully for 10 seconds. Of the following, the MOST appropriate next step in the management of this child is administration of:
Intravenous dexamethasone of 1 mg/kg
Intravenous fosphenytoin bolus at 20 mg/kg phenytoin equivalents over 10 minutes
Additional intravenous normal saline bolus of 20 mL/kg
Rapid intravenous lorazepam of 0.05 mg/kg
Intravenous prochlorperazine of 5 mg
A 2-month-old exclusively breast-fed infant presents to your office because his mother thinks that he is irritable. His mother reports that the infant has been passing loose stools and cries when he has a bowel movement. He is generally happy at other times. Physical examination demonstrates a healthy, afebrile, vigorous infant who has normal skin color. Cardiac, pulmonary, and abdominal examination findings are all normal. Anal inspection demonstrates no fissures. A stool specimen has reddish flecks, and the guaiac test is positive. Of the following, the BEST next step is to
Obtain an upper gastrointestinal radiography series
Send stool for Clostridium difficile toxin testing
Remove milk products from the maternal diet
Institute a trial of lansoprazole
Begin therapy with oral amoxicillin
You are seeing a 6-week-old infant who was born with trisomy 21 and a large atrioventricular septal defect. Over the previous week, she has tired with feeding and has not gained weight. Her respiratory rate is 60 breaths/min and heart rate is 150 beats/min. Auscultation reveals mild retractions and a 2/6 systolic murmur with a gallop rhythm. The liver is palpable at 2 cm below the costal margin, and the perfusion is good. You decide to increase the caloric content of the formula to 24 kcal/oz, and you contact her pediatric cardiologist to discuss referral for surgical repair. Of the following, the BEST therapeutic option while awaiting surgical repair is
Captopril
Furosemide
Hydralazine
Propranolol
Verapamil
A 10-year-old child is brought to your office for evaluation of a 1-day history of fever, vomiting, diarrhea, and abdominal pain. His mother states that he has vomited five times, and the emesis has been clear. He has had four episodes of nonbloody diarrhea. He describes his abdominal pain as crampy but cannot localize it to any specific part of his abdomen. He denies any symptoms of dysuria. On physical examination, the child is in no acute distress, his temperature is 99.2°F (37.3°C), heart rate is 102 beats/min, respiratory rate is 26 breaths/min, and blood pressure is 105/70 mm Hg. Results of examination of the head, neck, chest, and heart are normal. His abdomen is soft, and there is no guarding. There is no rebound tenderness. He complains of mild discomfort on deep palpation of his entire abdomen. He has hyperactive bowel sounds on auscultation, and he has no flank tenderness. Of the following, the MOST appropriate next step in the management of this patient is to
Obtain blood for a complete blood count
Send the patient home with instructions for supportive care
Administer intravenous fluids
Order frontal supine and upright abdomen radiographs
Obtain serum for electrolyte analysis
A 24-year-old woman is admitted to the gynaecology ward with a 4-day history of severe hyperemesis gravidarum. She has been unable to tolerate food or fluid orally for 2 days. On the second day of admission she develops signs of a severe pneumonia. This is presumed to be a hospital-acquired infection. She deteriorates rapidly. An arterial blood gas shows: pH 7.68; PO2 10.0 kPa; PCO2 4.26 kPa; HCO3 32 mmol/L; K+ 1.9 mmol/L; Lactate 1.2 mmol/L. What is the most accurate description of the acid-base disorder?
Metabolic alkalosis
Mixed metabolic alkalosis and respiratory alkalosis
Mixed respiratory alkalosis and metabolic acidosis
Respiratory alkalosis
Respiratory alkalosis with inadequate respiratory compensation
A 19-year-old woman is referred to accident and emergency with a fluctuant lower right abdominal pain which started over the course of the morning, associated with vomiting. There is rebound tenderness on examination. She is afebrile. Serum beta human chorionic gonadotrophin (hCG) is negative. An ultrasound shows free fluid in the peritoneal cavity but no other pathology to account for the pain. White cells are 14 * 109/L and the C-reative protein (CRP) is 184 mg/L. What is the most likely diagnosis?
Acute appendicitis
Tubo-ovarian abscess
Early ectopic pregnancy
Pelvic inflammatory disease (PID)
Ovarian torsion
Two days after undergoing posterior exenteration for recurrence of cervical adenocarcinoma a 53-year-old woman develops a tachypnoea, tachycardia of 125 bpm and a fever of 39° Blood cultures have grown methicillin-resistant Staphylococcus aureus (MRSA). She requires intravenous vasopressors. What is the most appropriate diagnosis?
Sepsis
Septic shock
Septicaemia
Adult respiratory distress syndrome
Systemic inflammatory response syndrome
An 18-year-old girl presents with heavy irregular periods, postcoital bleeding and deep dyspareunia for the last six months. Which of the following is the likely diagnosis?
Polycystic ovarian syndrome
Anovulatory cycles
Granulosa cell ovarian tumour
Fibroids
Chronic pelvic inflammatory disease
An 18-year-old female presents with a four-month history of secondary amenorrhoea followed by a week of intermittent light vaginal bleeding. She has gained approximately one stone in weight over this time. Which of the following is the likely diagnosis?
Anorexia nervosa
Anovulatory cycles
Chronic pelvic inflammatory disease
Pregnancy
Polycystic ovairian syndrome
A 21-year-old comes to the clinic with a history of intermenstrual bleeding for the last 6 weeks. She has regular periods and does not experience post-coital bleeding. She is not on the oral contraceptive pill and has no other past medical history. What is the most appropriate first line investigation?
Triple swabs for pelvic infection
Pipelle biopsy
Hysteroscopy and biopsy
Ultrasound scan of the pelvis
Cervical smear test
A 32-year-old woman is rushed to accident and emergency as the viction of a high speed vehicle collision. She is 35 weeks pregnant and unconscious. There is evidence of blunt abdominal trauma and she is showing signs of grade 3 hypovolaemic shock. The consultant obstetrician on call immediately attends the resus call and recommends immediate perimortem caesarean delivery in a resuscitative effort to improve the management of her shock. Her husband has been brought into resus by the police, and insists that she would refuse caesarean section under any circumstances. What is the most appropriate management?
Admit to the intensive care unit and begin infusing inotropes to restore the cardiac output
Replacement of the lost circulating volume with blood products
Resucitation and transfer to the obstetric theatre for emergency caesarean delivery
Rapid fluid resuscitation until the situation regarding the patient’s wishes becomes clear
Immediate caesarean delivery
A 61-year-old woman has recently been diagnosed with a stage 1a endometrial carcinoma. She has had four children, she has mild utero-vaginal prolapse and she has never been operated on. She needs to have surgery. You see her in clinic and talk about the different operations available to her. Which is the most appropriate operation?
Wertheim’s hysterectomy
Laparoscopic hysterectomy
Total abdominal hysterectomy
Posterior exenteration
Subtotal hysterectomy
A 42-year-old woman is in her first pregnancy. She conceived with in vitro fertilization (IVF) and has had a straightforward pregnancy so far. At 25 weeks’ gestation she is seen in clinic with a blood pressure of 142/94 mmHg and protein + in her urine. A protein creatinine ratio (PCR) comes back as 19. She says that her blood pressure is often up at the doctor’s. With the information you have to hand what is the most likely diagnosis?
Conn’s syndrome
Pre-eclampsia
White coat hypertension
Pregnancy-induced hypertension
Essential hypertension
A 24-year-old woman who is 9 weeks pregnant is brought to accident and emergency by ambulance with left iliac fossa pain and a small vaginal bleed. An abdominal ultrasound scan performed at the bedside demonstrates a corneal pregnancy and free fluid in the pelvis. Her observations are: pulse 119 bpm, blood pressure 74/40 mmHg, respiratory rate 24/minute. What is the most appropriate definitive management?
Diagnostic laparoscopy
Transvaginal ultrasound scan
Serum beta hCG estimation
Admission to the gynaecology ward and fluid resuscitation
Urine pregnancy test
A 24-year-old woman attends the antenatal clinic. She has had a glucose tolerance test which is abnormal. A diagnosis of gestational diabetes is mad The primary purpose of this appointment is to explain to her what gestational diabetes means to her and her baby. You explain to her that sugar control is important and there are specific glucose ranges that she should try to adhere to. Which of the following would be correct advice for this woman?
Post meal 2-hour blood sugar <7.8 μmol/L
Pre meal blood sugar <7.1 μmol/L
Post meal 1-hour sugar <7.8 μmol/L
Pre meal blood sugar <7.8 μmol/L
Post meal 1-hour sugar <11.1 μmol/L
A 28-year-old woman attends her GP clinic for routine cervical screening. Liquid based cytology (LBC) shows mild dyskaryosis. A repeat sample again shows mild dyskaryosis. What is the most appropriate management?
Knife cone biopsy of the cervix
Repeat the LBC smear test in 3 months
Arrange colposcopy at the gynaecology clinic
Repeat the LBC smear test in 6 months
Large loop excision of the transformation zone
A 20-year-old female attends clinic requesting advice on appropriate contraception. She has a steady relationship and has no desire to start a family. There are no risk factors for venous thrombosis in her family history and she drinks approximately 12 units of alcohol each week. Apart from acne, she is otherwise fit and well. She has a body mass index of 35.5 kg/m2 and a blood pressure of 122/70 mmHg. Which of the following contraceptives would be most appropriate for this patient?
Depot progesterone
Condoms
Combined oral contraceptive
Progesterone only pill
Diaphragm with spermicial gel
A 58-year-old woman presents to the clinic with post-menopausal bleeding. A pipelle biopsy confirms adenocarcinoma of the endometrium. Further imaging of the pelvis shows that there is spread of the tumour outside of the uterus into the left adnexa. There is no other spread. What is the most likely stage of the tumour?
Stage IIIC2
Stage IIIA Correct
Stage 1A
Stage 1A
Stage II
A 24-year-old woman who is 32 weeks pregnant presents to the labour ward with a terrible headache that has not improved despite analgesic. It started 2 days ago and came on suddenly. She has stayed in bed as it hurts to be in sunlight and she vomited twice this morning. Her past medical history includes a macroprolactinoma (which has been removed) and occasional migraines. She is haemodynamically stable with no focal neurology or papilledema. You arrange for her to have a CT of her head as an emergency, which adds no further information to aid your diagnosis. There are red cells on lumbar puncture but no organisms are isolate What is the most likely diagnosis?
Viral meningitis
Subarachnoid haemorrhage (SAH)
Cerebral vein thrombosis (CVT)
Migraine
Idiopathic intracranial hypertension (IIH)
A 28-year-old woman attends accident and emergency unable to walk because she is so faint. She has had heavy vaginal bleeding for 4 hours since she engaged in sexual intercourse with a new partner, which she described as ‘rough and very painful’. She is still bleeding and cannot tolerate vaginal examination due to the pain. A point-of-care haemoglobin estimation is 6.4 g/dL and she is haemodynamically unstable. What is the most appropriate management?
Admit, resuscitate and prepare her for immediate transfer to theatre
Admit to the gynaecology ward, cross-match four units of packed red cells and send a formal full blood count
Admit to the gynaecology ward having packed the vagina
Discharge with oral iron supplementation and follow up in the gynaecology clinic in 2 days
Discharge with oral iron supplementation and follow up on the ward in 24 hours
A 10-year-old boy presents with a history of multiple episodes of moderately severe epistaxis that resolve with conservative management. The most recent attack required hospital admission. He also describes multiple episodes of having a ‘stuffy noise’ associated with mild headaches. During these episodes his mother thinks he looks ‘puffy’. There is no history of foreign body inhalation or nasal trauma. He does not suffer from easy bruising. Which one of the following is the most likely diagnosis?
Juvenile nasal angiofibroma
Allergic rhinitis
Nasal polyps
Trauma to Little’s area
Leukaemia
A 32-year-old female patient presents with a 6-week history of bloody bowel motions. She has noticed significant weight loss over the preceding 6 weeks with increasing lethargy and fatigue. She has previously had constipation and admits to regular laxative use. What is the most likely diagnosis?
Diverticular disease
Irritable bowel syndrome
Anal fissure
Inflammatory bowel disease
Bowel cancer
A 40-year-old man complains of progressive swelling of his right leg over the past 6 months. He has had episodes of high-grade fever for 4 months, during which the leg becomes red and painful with increase in the size of the swelling. On examination, the girth of the affected limb is found to be increased, and the skin is very thick and rough. The swelling of the limb does not pit with pressure. Blood examination reveals the presence of marked eosinophilia. What is the diagnosis of this patient?
Hydatid disease
Amoebic liver abscess
Filariasis
Actinomycetoma
Ascariasis
A 43-year-old man presents with sudden right arm and leg weakness. He is normotensive. CT demonstrates a substantial haematoma in the left frontoparietal region. What is the most likely diagnosis of this patient?
Hypertensive intracerebral haemorrhage
Dural AV fistula rupture
Berry aneurysm rupture
Arteriovenous malformation rupture
Pituitary apoplexy
A 20-year-old male student attends the surgical outpatient clinic with a pulsatile ovoid swelling just behind the anterior edge of the sternocleidomastoid (SCM) muscle at the level of the hyoid bone. It is elastic in consistency and can be moved from side to side only. This is likely to be a?
Thyroglossal cyst
Branchial sinus
Chemodectoma
Cystic hygroma
Branchial cyst
A 47-year-old woman has a 12-week history of tingling and numbness in the hand, which is worse at night. On examination, there is wasting of the thenar eminence. What is the most likely diagnosis?
Cubital tunnel syndrome
Boutonnière deformity
De Quervain’s tenosynovitis
Dupuytren’s disease
Carpal tunnel syndrome
A 15-year-old girl presents with pain at the base of the second toe. Radiographs demonstrate an abnormal second metatarsal head with flattening. What is the most likely diagnosis?
Fracture of the second metatarsal
Hallux rigidus
Freiberg’s disease
Metatarsalgia
Heel bumps
A 27-year-old patient presents with a 3-month history of increasing difficulty in swallowing. He first noticed the problem when drinking fluids, but is now commonly experiencing it when eating food as well. He has presented as regurgitation of food is becoming a problem and he has noticed unintentional weight loss. A chest radiograph shows a widened mediastinum. What is the most likely diagnosis?
Plummer–Vinson syndrome
Oesophageal malignancy
Oesophageal spasm
Thoracic aortic aneurysm
Achalasia
A 38-year-old runner complains of increasing pain in her right big toe that she fractured many years ago. The first metatarsophalangeal joint is red dorsally and has a very limited range of painful movement. The patient wants to be able to continue running. What is the most likely diagnosis?
Hallux rigidus
Charcot–Marie Tooth
Hammer toes
Hallux valgus
Curly toes
A 20-year-old footballer is involved in a heavy tackle where another player impacts with outside of his knee. He feels pain over the inner aspect of his knee, and he has a positive valgus stress test but with a firm end point. What is the most likely diagnosis?
Medial collateral ligament injury Correct
Anterior cruciate ligament injury
Patella dislocation
Posterior cruciate ligament injury
Lateral collateral ligament injury
A 6-year-old Asian boy is brought to the paediatric emergency department by his mother. She is worried because the boy is lethargic and has been complaining of right-sided earache all day. There have been no similar attacks in the past. On examination, he looks unwell, and his temperature is 39.0°C, pulse rate is 110beats/min and blood pressure is 90/40 mmHg. There is no cervical lymphadenopathy. Otoscopic examination reveals a bright red right tympanic membrane. You decide to take a microbiology swab. Which one of the following is the most likely pathogen?
Mycobacterium tuberculosis
Group B streptococcus
None of the above
Moraxella catarrhalis
Haemophilus influenza
A patient has a hyperflexion injury. The x-ray shows that the vertical height of C4 vertebra is 50% less at the front than the back. What is the most likely diagnosis of this patient?
Facet dislocation
Jefferson’s fracture
Wedge fracture
Teardrop fracture
Hangman’s fracture
A 62-year-old cleaner presents with multiple episodes of uncontrolled right arm jerking, unsteadiness while walking, and difficulty seeing objects to one side and occasional headaches over the past several weeks. She is otherwise fit and well without any significant past medical history. Examination reveals increased lower limb tone, reduced power in the legs and papilloedema on fundoscopy. In addition, there appears to be a bony protuberance overlying the right parietal bone. A head CT scan with contrast is performed which shows a dense, homogeneous lesion in the right parasagittal area. This lesion is likely to represent what type of cranial tumour?
Oligodendroglioma
Craniopharyngioma
Meningioma
Astrocytoma
Medulloblastoma
An 18-year-old student presents with a 6-month history of a painless lump in her right breast. She is currently mid cycle and does not report any cyclical change in the lump. On examination a 3 cm × 2 cm lump is found in the inner lower quadrant of the right breast as well as a 1 cm × 0.5 cm lump in the upper outer quadrant of the same breast. Both are smooth on palpation and have sharp edges. They slip easily between the examining fingers of the physician. The primary problem is likely to be a?
Phylloides tumour
Mammary duct ectasia
Fibroadenosis
Fibroadenoma
Breast cyst
A 54-year-old builder attends your outpatient clinic with his wife, reporting an 8-month history of a lump on the left side of his face, in front of his ear. It is painless and does not trouble him. He has attended on the insistence of his wife, who is worried that it may be growing larger. On examination, the swelling appears to lie anterior to the angle of the jaw on the left side. It is non-tender and approximately 5 cm in diameter with a clear edge. The skin is easily moved on top of it and the lump itself feels rubbery to touch. There is no cervical lymphadenopathy or facial droop evident on examination. An aspirate is taken which shows cells of many different types. A decision is made at a follow-up appointment to excise the lump under anaesthesia. This is likely to be?
Mikulicz’s syndrome
Carcinoma of the parotid gland
Sjörgen’s syndrome
Adenolymphoma (Warthin’s tumour)
Pleomorphic adenoma
A 62-year-old man underwent a coronary artery bypass grafting 8 months ago. The longitudinal scar on his sternum has increased in width, is itchy and is cosmetically unsightly. What is the diagnosis of this patient?
Keloid
Hypertrophic scar
Compartment syndrome
Necrotising soft-tissue infection
Contracture
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