6 free sample questions. The full bank has hundreds more in this category.
A 53-year-old man presents to the emergency department with progressive abdominal distension over several weeks. On examination the abdomen is protuberant with a positive fluid wave but no focal tenderness. Right upper quadrant percussion suggests an enlarged liver. He also has scleral icterus, erythema of both palms, and rounding of the proximal nail folds consistent with clubbing. Which of the following is most likely to be present in this patient's history?
A 31-year-old woman with a loop ileostomy fashioned after emergency laparotomy for blunt bowel trauma re-presents to the emergency department with malaise and reduced stoma output over several days. Observations show a temperature of 37.2°C, heart rate 116 bpm, blood pressure 105/70 mmHg, respiratory rate 12/min and SpO2 98% on room air. Which of the following complications is she most likely to be experiencing as a result of her ileostomy?
A 45-year-old woman presents to the emergency department with several months of progressively worsening dysphagia to solids, increasing fatigue, and a sore, smooth tongue. She denies odynophagia, weight loss, reflux, or food bolus impaction, but reports heavy menstrual bleeding for the past year and occasional light-headedness on standing. On examination she is pale with angular cheilitis, glossitis with a smooth erythematous tongue, and koilonychia. Vital signs are HR 102/min, BP 106/68 mmHg, RR 16/min, SpO2 98% on room air, afebrile. Abdominal examination is unremarkable. Bloods show Hb 89 g/L, MCV 70 fL, ferritin 8 µg/L, and transferrin saturation 8%. Barium swallow and subsequent upper endoscopy demonstrate a thin, membranous web in the upper (post-cricoid) oesophagus. What is the most likely diagnosis?
A 42-year-old man is reviewed in the emergency short-stay clinic after being referred by his GP for abnormal liver function tests found on routine screening. He reports mild fatigue but no jaundice, ascites or confusion. He has a history of past intravenous drug use but has been abstinent for over a decade. Examination reveals no stigmata of chronic liver disease and normal vital signs. Serology confirms chronic hepatitis C infection, genotype 1, with a viral load of 5 million IU/mL. FibroScan shows F2 (moderate) fibrosis without evidence of cirrhosis. He has no HIV or hepatitis B co-infection. He asks what treatment is currently recommended. Which of the following best reflects current first-line management in Australia?
A 30-year-old man who has sex with men presents to the sexual health clinic with a 3-month history of perianal itching and a lump he noticed while showering. He is HIV-negative, has no significant past medical history and takes no regular medications. He reports unprotected receptive anal intercourse with multiple partners over the past year and has never received HPV vaccination. On examination, there are several soft, non-tender, cauliflower-like papules clustered around the anal verge, with no induration, ulceration or inguinal lymphadenopathy. Digital rectal examination and anoscopy show no mass, bleeding or intraluminal lesions. A punch biopsy of the largest lesion confirms condyloma acuminatum with koilocytosis, positive for HPV subtypes 6 and 11, and no evidence of high-grade squamous intraepithelial lesion (HSIL) or invasive carcinoma. Which of the following is the most appropriate next step in management?
A 35-year-old man is brought to the emergency department after a single stab wound to the right groin sustained 30 minutes ago. He is confused, pale and diaphoretic. Observations show BP 72/40 mmHg, HR 142 beats/min, RR 28/min and GCS 13. There is no visible external bleeding at the wound site, but a FAST scan shows free fluid in the pelvis and a CT is not feasible given his instability. Massive transfusion protocol has been activated and he has received 4 units of packed red cells, FFP and tranexamic acid with only transient improvement in blood pressure. Presumed retroperitoneal haemorrhage from a pelvic or iliac vessel injury is suspected, and the trauma team is considering resuscitative endovascular balloon occlusion of the aorta (REBOA) as a bridge to definitive haemorrhage control. Which of the following best describes REBOA?