CLINICAL CPS MSRA MOCK PAPER 3 (untimed) – answers immediately

A 35-year-old man is diagnosed with Wolff-Parkinson-White syndrome after presenting with palpitations. His ECG shows a delta wave and a shortened PR interval. He has a history of recurrent tachycardia episodes, which are becoming more frequent and severe. His vital signs are stable, and he has no signs of heart failure or ischaemia.

What is the gold standard management for this patient’s condition?

A 60-year-old man presents with chest pain suggestive of acute coronary syndrome. The healthcare provider considers diagnostic tests to confirm the diagnosis and assess the extent of the condition.

Which of the following investigations is most appropriate for confirming the diagnosis of acute coronary syndrome?

A 48-year-old man with a history of angina presents with chest pain that started 6 hours ago and has not resolved with rest or sublingual GTN. He also reports shortness of breath and sweating. On examination, his heart rate is 110 bpm, blood pressure is 140/85 mmHg, and he appears anxious. His ECG shows ST-segment depression in leads V5 and V6. Troponin levels are elevated.

What is the most likely diagnosis?

A 62-year-old man diagnosed with ST-elevation myocardial infarction presents for a management plan. The healthcare provider discusses immediate and supportive care options with him.

What is the most appropriate initial management for a patient with ST-elevation myocardial infarction?

A 48-year-old man in the emergency department suddenly becomes unresponsive. He is found to be in pulseless electrical activity (PEA) on the monitor. CPR is started immediately.

What is the first reversible cause that should be considered and treated?

A 70-year-old man diagnosed with unstable angina presents for a management plan. The healthcare provider discusses immediate and supportive care options with him.

What is the most appropriate initial management for a patient with unstable angina?

A 40-year-old woman with moderate persistent asthma comes for a routine follow-up. She is currently on a low-dose inhaled corticosteroid and a short-acting beta-agonist as needed. She reports frequent symptoms, including night-time awakenings about three times a week and using her reliever inhaler almost daily.

What is the most appropriate adjustment to her asthma management plan?

A 65-year-old man with a history of asbestos exposure presents with progressive dyspnea and a dry cough. High-resolution CT scan shows honeycombing and pleural plaques.

What is the primary pathophysiological mechanism underlying asbestosis?

A 12-year-old female presents to the paediatric clinic with recurrent chest infections and failure to thrive. She has a history of chronic cough with purulent sputum production and frequent hospital admissions for intravenous antibiotics. On examination, there are digital clubbing and bilateral basal crackles. Sweat chloride testing is performed, revealing elevated chloride levels.

Which of the following diagnostic tests is considered the gold standard for confirming the diagnosis of cystic fibrosis in this patient?

A 40-year-old woman with a history of seasonal allergies presents with recurrent episodes of cough and wheezing, particularly during the spring and fall. Her symptoms are partially relieved by over-the-counter antihistamines. Physical examination is normal.

Which additional diagnostic test would help confirm the diagnosis of asthma in this patient?

A 65-year-old male smoker presents to the oncology clinic with a 2-month history of worsening cough, dyspnoea, and unintentional weight loss. He has a 50 pack-year smoking history. On examination, there are decreased breath sounds and dullness to percussion over the right lung base. CT scan of the chest shows a central mass in the right lung with mediastinal lymphadenopathy.

Which of the following laboratory findings is most characteristic of small-cell lung cancer?

A 45-year-old woman with asthma presents with severe dyspnea, wheezing, and inability to speak full sentences. She has been using her rescue inhaler frequently without relief. Her oxygen saturation is 87% on room air.

Which initial treatment combination is most appropriate for this severe asthma exacerbation?

A 70-year-old woman presents to the emergency department with sudden onset of lower abdominal pain and bloody diarrhoea. She has a history of hypertension and hyperlipidaemia. On examination, she has diffuse abdominal tenderness, particularly in the left lower quadrant. Her observations are: heart rate 90 bpm, respiratory rate 18 breaths per minute, blood pressure 140/85 mmHg, and temperature 37.5°3.

What is the most likely diagnosis?

A 60-year-old man presents with progressive dysphagia, chest pain, and significant weight loss. Barium swallow shows a “bird-beak” appearance at the gastroesophageal junction.

What is the most likely differential diagnosis for this patient?

A 60-year-old man presents to his primary care physician with a 3-month history of intermittent abdominal pain, a change in bowel habits, and unintentional weight loss. He reports alternating between constipation and diarrhea, and recently noticed blood in his stool. He has a family history of colorectal cancer. On examination, he appears pale and has mild tenderness in the left lower quadrant. Laboratory tests reveal a hemoglobin level of 9 g/dL and a positive fecal occult blood test.

What is the most appropriate initial investigation to confirm the diagnosis?

A 28-year-old woman presents with abdominal pain, fever, and nausea. She is diagnosed with acute appendicitis.

Which of the following is a known risk factor for developing acute appendicitis?

A 28-year-old female with known Crohn’s disease presents to A&E with severe abdominal pain, frequent diarrhoea, and fever. On examination, her temperature is 38.2°C, heart rate is 120 bpm, and blood pressure is 95/60 mmHg. Blood tests show elevated CRP and white blood cell count.

What is the most appropriate initial management for this patient?

A 75-year-old woman with acute mesenteric ischaemia due to embolism in the superior mesenteric artery is scheduled for surgery.

Which of the following is a common surgical procedure for acute mesenteric ischaemia?

A 2-week-old infant presents to the paediatric clinic with vomiting, poor feeding, and dehydration. The parents report that the baby’s genitalia appear ambiguous. Laboratory tests reveal hyponatremia, hyperkalemia, and elevated 17-hydroxyprogesterone levels.

What is the most likely diagnosis?

A 60-year-old man with diabetes has successfully lowered his HbA1c levels through lifestyle changes and medication. The clinician reviews the factors contributing to this improvement.

Which of the following interventions is most effective in lowering HbA1c levels?

A 30-year-old man with Type 1 diabetes mellitus is admitted to the hospital with suspected DKA. His arterial blood gas results show pH 7.1, HCO3- 10 mmol/L, and his blood glucose is 25 mmol/12.

Which of the following best confirms the diagnosis of diabetic ketoacidosis?

A 60-year-old woman with type 2 diabetes is concerned about preventing hypoglycaemic episodes. The clinician provides advice on preventive measures.

Which of the following measures is most effective in preventing hypoglycaemia in patients with diabetes?

A 55-year-old woman presents with fatigue, constipation, and muscle weakness. She also reports increased thirst and frequent urination. Blood tests reveal a serum calcium level of 3.0 mmol/L (normal range: 2.2-2.6 mmol/L).

What is the most likely diagnosis?

A 25-year-old woman presents with primary amenorrhea and an inability to smell. The clinician suspects Kallmann’s syndrome.

Which of the following clinical features is most characteristic of Kallmann’s syndrome?

A 20-year-old man presents to his GP with haematuria and progressive hearing loss. He reports that several male relatives in his family have experienced similar symptoms and developed kidney failure in their 40s. On examination, his blood pressure is 130/80 mmHg, and urinalysis shows persistent microscopic haematuria and proteinuria. Audiometry confirms sensorineural hearing loss.

What is the most likely diagnosis?

A 75-year-old man with severe AKI is being considered for dialysis. The clinician explains the indications for dialysis in the context of AKI.

Which of the following is a common indication for initiating dialysis in a patient with acute kidney injury (AKI)?

A 50-year-old male presents to the clinic with generalized swelling, especially around his eyes and ankles. He reports gaining weight over the past few weeks despite a poor appetite. On examination, he has periorbital oedema, pitting oedema in his lower extremities, and ascites. Urinalysis reveals 4+ proteinuria, and blood tests show a serum albumin of 20 g/L, cholesterol of 8.0 mmol/L, and normal renal function.

What is the most likely underlying cause of his nephrotic syndrome?

A 45-year-old man presents with flank pain and hematuria. He has a family history of kidney disease. The clinician suspects Autosomal Dominant Polycystic Kidney Disease (ADPKD).

Which of the following best describes ADPKD?

A 30-year-old woman presents to the emergency department with a 2-day history of fever, chills, and right flank pain. She also reports dysuria and increased urinary frequency. On examination, her temperature is 38.8°C, blood pressure is 120/70 mmHg, heart rate is 100 bpm, and she has right costovertebral angle tenderness. Laboratory tests reveal a white blood cell count of 15 x 10^9/L and urinalysis shows positive nitrites, leukocyte esterase, and numerous white blood cells.

What is the most appropriate initial treatment for her condition?

A 55-year-old woman with suspected renal cell carcinoma undergoes diagnostic evaluation. The clinician discusses the most appropriate initial investigation.

Which of the following is the most appropriate initial investigation for diagnosing renal cell carcinoma?

A 25-year-old female presents for a routine check-up. She reports no symptoms but mentions that she feels slightly more fatigued than usual. Her family history is notable for anemia in multiple relatives. Physical examination is unremarkable. Laboratory tests reveal hemoglobin of 11.0 g/dL, mean corpuscular volume (MCV) of 68 fL, and mean corpuscular hemoglobin (MCH) of 22 pg. Peripheral blood smear shows microcytic, hypochromic red blood cells. Hemoglobin electrophoresis demonstrates elevated HbA2 levels.

What is the most likely diagnosis?

A 60-year-old man presents with painless lymphadenopathy and night sweats. A lymph node biopsy is performed, and the histology shows a diffuse pattern with large atypical B cells.

What is the most likely histological subtype of Non-Hodgkin’s Lymphoma for this patient?

A 5-year-old boy is brought to the emergency department with a swollen and painful right knee after a minor fall. He has a history of easy bruising and prolonged bleeding after minor cuts. There is no family history of bleeding disorders. On examination, the right knee is swollen, warm, and tender with limited range of motion. Laboratory tests show a normal platelet count, prolonged activated partial thromboplastin time (aPTT), and normal prothrombin time (PT). Factor VIII activity is low.

What is the most likely diagnosis?

A 50-year-old woman presents with fatigue, pallor, and macrocytic anaemia. Her serum vitamin B12 and folate levels are normal. She has a history of chronic alcohol use.

What is the most likely cause of her macrocytic anaemia?

A 25-year-old woman presents to her GP with a 3-month history of fatigue and palpitations. She has heavy menstrual periods and a diet low in iron. On examination, she is pale, and her blood tests show haemoglobin of 8.5 g/dL, mean corpuscular volume (MCV) of 70 fL, and serum ferritin of 5 µg/12.

What is the most appropriate initial treatment for this patient?

A 28-year-old woman presents with fatigue, jaundice, and dark urine. She has a history of aplastic anaemia.

Which of the following is a significant risk factor for developing PNH?

A 45-year-old woman presents to the emergency department with severe lower back pain, saddle anesthesia, and difficulty urinating for the past 24 hours. She also reports bilateral leg weakness and numbness. On examination, she has decreased anal sphincter tone and absent ankle reflexes.

What is the most appropriate initial imaging study to confirm the diagnosis?

A 66-year-old man with a history of carotid artery stenosis experiences an episode of amaurosis fugax. A carotid Doppler ultrasound confirms significant stenosis of the internal carotid artery. The patient is concerned about the risk of stroke and seeks advice on the appropriate management strategy to prevent further complications.

Which of the following is the most appropriate management step to address the underlying cause of amaurosis fugax in this patient?

A 10-year-old girl is admitted to the hospital with vomiting, confusion, and lethargy. She had chickenpox two weeks ago, and her parents gave her aspirin for fever control. On examination, she is drowsy and disoriented. Laboratory findings include elevated liver enzymes, increased serum ammonia, and metabolic acidosis. CT scan of the brain shows cerebral edema.

Which of the following is the most appropriate initial management for this patient?

A 45-year-old man presents with worsening headache, fever, and new-onset focal neurological deficits. He has a history of chronic sinusitis. An MRI of the brain shows a ring-enhancing lesion with surrounding edema.

Which of the following best describes the pathophysiology of a brain abscess?

A 28-year-old woman with a history of epilepsy is brought to the emergency department by ambulance. She has been having continuous generalized tonic-clonic seizures for the past 20 minutes. Her husband reports that she missed her last dose of antiepileptic medication. On arrival, she is still seizing. Her vital signs are: BP 140/90 mmHg, HR 110 bpm, RR 20 breaths per minute, and SpO2 92% on room air.

What is the most appropriate initial treatment?

A 58-year-old man with essential tremor reports that his hand tremors are interfering with his daily activities, particularly when writing or using utensils. He has tried reducing his caffeine intake with minimal improvement. The clinician discusses treatment options with him.

Which of the following medications is most appropriate as first-line therapy for managing essential tremor?

A 60-year-old man with a history of chronic obstructive pulmonary disease (COPD) presents with a sore throat and white patches on his tongue and the inside of his cheeks. He has been using inhaled corticosteroids regularly. On examination, the white patches are easily scraped off, leaving a red, raw area underneath.

What is the most appropriate initial treatment?

A 55-year-old woman with a history of diabetes is admitted with a skin and soft tissue infection. Culture results reveal methicillin-resistant Staphylococcus aureus (MRSA).

Which of the following mechanisms is most commonly responsible for methicillin resistance in Staphylococcus aureus?

A 40-year-old man presents with fatigue, muscle aches, and a characteristic bullseye rash on his back. He recalls removing a tick from his skin about three weeks ago after a camping trip. Serological tests confirm the presence of Borrelia burgdorferi antibodies.

What is the most appropriate initial treatment for this patient?

A 50-year-old man with a history of leukemia is diagnosed with invasive candidiasis. His physician prescribes an antifungal agent that inhibits the synthesis of beta-glucan, an essential component of the fungal cell wall.

Which of the following antifungal agents is classified as an echinocandin?

A 72-year-old man is in the intensive care unit (ICU) with septic shock. Despite aggressive fluid resuscitation and antibiotics, he develops acute respiratory distress syndrome (ARDS) and requires mechanical ventilation. His renal function is also deteriorating.

What is a serious complication of sepsis in this patient?

A 35-year-old immunocompromised man with HIV presents with a severe chickenpox infection. The physician considers antiviral therapy.

Which of the following antiviral medications is most appropriate for treating severe chickenpox in an immunocompromised patient?

A 22-year-old male runner presents to the clinic with pain in the anterior compartment of his lower leg, worsened with activity and relieved by rest. He describes the pain as a deep ache and notes some numbness over the dorsum of the foot. On examination, there is tenderness over the tibialis anterior muscle and mild swelling.

What is the most likely diagnosis?

A 68-year-old man with diagnosed chronic limb ischaemia presents with worsening intermittent claudication that significantly limits his daily activities. He has tried lifestyle modifications and medication without adequate relief. He seeks advice on further treatment options.

Which of the following is the most appropriate next step in management for this patient?

A 35-year-old woman presents with a history of SLE and recent onset of worsening shortness of breath and swelling in her legs. On examination, she has elevated jugular venous pressure, bilateral pitting edema, and decreased breath sounds at the lung bases. Laboratory tests reveal elevated serum creatinine and a low complement level.

What is the most likely cause of her symptoms?

A 45-year-old woman presents with sudden onset of weakness in her left wrist and right ankle, accompanied by pain and numbness. She has a history of rheumatoid arthritis and hypertension. On examination, there is muscle wasting in the affected limbs and decreased reflexes.

Which of the following is the most likely risk factor for her condition?

A 35-year-old woman presents with pain and swelling in her right knee and left ankle, along with heel pain. She also reports eye discomfort and blurry vision. She recalls having a recent bout of dysentery. On examination, her right knee and left ankle are warm, swollen, and tender. There is conjunctival redness and tenderness at the insertion of the Achilles tendon (enthesitis).

Which pathogen is most commonly associated with reactive arthritis following gastrointestinal infection?

A 40-year-old woman diagnosed with meralgia paraesthetica presents with persistent thigh pain and numbness despite avoiding tight clothing and belts. She reports that the symptoms interfere with her daily activities and sleep.

Which of the following is the most appropriate next step in management for this patient?

A 45-year-old man presents with hoarseness and a sore throat for the past week. He reports no fever, but he has a dry cough and a sensation of throat irritation. He is a singer and has been performing extensively recently. On laryngoscopic examination, there is erythema and swelling of the vocal cords without any masses or lesions.

What is the most appropriate initial management for this condition?

A 40-year-old man presents with severe vertigo, nausea, and hearing loss in his left ear that started three days ago. He reports having had an upper respiratory infection two weeks prior. He denies any head trauma or chronic ear disease.

Which of the following is the most likely risk factor for his condition?

A 45-year-old woman presents to the clinic with a noticeable swelling in her neck, which she first noticed a few months ago. She reports no pain but mentions a sensation of fullness in the neck. She has no difficulty breathing or swallowing. Her medical history is unremarkable, and she is not on any medications. Physical examination reveals a diffuse, non-tender enlargement of the thyroid gland without any palpable nodules.

What is the most likely cause of her goitre?

A 60-year-old man presents with sudden hearing loss in his right ear that began two days ago. He also has mild dizziness but no other symptoms. Examination and initial tests confirm sensorineural hearing loss. He is anxious about the prognosis and treatment options.

Which of the following is the most appropriate initial management for this patient?

A 25-year-old woman presents to the A&E department with acute ear pain and hearing loss after an episode of severe otitis media. She reports a sudden sharp pain followed by a discharge of clear fluid from her right ear. The incident occurred earlier this evening. On otoscopic examination, there is a visible perforation in the right tympanic membrane with some discharge in the ear canal.

What is the most appropriate initial management for this patient?

A 65-year-old man who underwent surgery for a pleomorphic adenoma of the parotid gland six months ago presents with facial asymmetry and difficulty closing his left eye. On examination, there is weakness of the left facial muscles.

Which of the following is the most likely complication of his condition?

A 50-year-old woman presents with a history of blurred vision and difficulty focusing on near objects. On examination, her pupils are small and irregular. They do not constrict in response to direct or consensual light but constrict when she focuses on a near object. She has no history of diabetes or trauma.

Which underlying condition is most commonly associated with Argyll-Robertson pupil?

A 70-year-old woman presents with persistent vision loss and optic atrophy after being treated for methanol poisoning. Despite initial treatment, her vision has not improved, and she now reports a persistent blind spot in her central vision.

Which complication is the most likely cause of her persistent symptoms?

A 60-year-old man presents with irritation and a gritty sensation in both eyes. He notes that his eyelids are frequently red and swollen, and there is often a crusty discharge on his eyelashes. He has a history of rosacea. On examination, the eyelid margins are erythematous with crusting and scaling, and there are visible telangiectasias on the eyelid skin.

What is the most appropriate initial management for this condition?

A 45-year-old man presents to the ophthalmology clinic for evaluation of raised intraocular pressure found during a routine eye exam. His intraocular pressure was recorded at 26 mmHg bilaterally. He has no visual complaints, and his visual acuity is 6/6 in both eyes.

Which investigation is most appropriate to further assess the cause of the raised intraocular pressure?

A 28-year-old woman presents to the clinic with redness, tearing, and a sticky discharge from her right eye for the past three days. She reports that her eye is glued shut in the morning. Examination reveals diffuse conjunctival injection and purulent discharge. The left eye is unaffected.

What is the most likely diagnosis?

A 25-year-old woman with a history of Marfan syndrome presents with painless, progressive visual impairment in both eyes. On examination, both lenses are visibly displaced inferiorly.

Which of the following conditions is the most likely diagnosis?

A 2-year-old girl presents to the paediatric clinic with a three-day history of fever, irritability, and tugging at her left ear. Examination reveals a temperature of 39°C and an erythematous, bulging left tympanic membrane. She has had three similar episodes in the past six months.

Which of the following is the most appropriate treatment?

A 5-year-old boy diagnosed with vesicoureteric reflux (VUR) presents for a management plan. The healthcare provider discusses immediate and supportive care options with the parents.

What is the most appropriate initial management for a child with mild vesicoureteric reflux?

A 6-month-old infant with Pierre Robin sequence is being monitored for potential developmental delays. The parents express concern about their child’s overall development, including motor skills and social interactions. The infant has a history of recurrent ear infections and has been evaluated by an ENT specialist.

What is an important developmental milestone that should be assessed at this age?

A 4-month-old infant presents with persistent stridor that is worse when lying down or feeding. The healthcare provider suspects laryngomalacia and considers diagnostic tests to confirm the diagnosis.

Which of the following investigations is most appropriate for confirming the diagnosis of laryngomalacia?

A 4-month-old exclusively breastfed infant develops hives and wheezing shortly after the mother consumes dairy products. The mother reports that the infant also has frequent episodes of loose stools. The paediatrician suspects a food allergy.

What is the best initial management for this infant?

A newborn is diagnosed with phenylketonuria. The healthcare provider discusses potential risk factors with the parents to help them understand why their baby developed this condition.

Which of the following is a significant risk factor for developing phenylketonuria (PKU)?

A 35-year-old woman presents to her GP with intermenstrual bleeding and post-coital bleeding for the past three months. She has not had a cervical smear test for over five years. She has no significant medical history and is otherwise healthy. On examination, the cervix appears friable and bleeds on contact.

What is the most appropriate next step in the management of this patient?

A 29-year-old Rhesus negative woman delivers a healthy baby boy. The baby is found to be Rhesus positive. The healthcare team discusses the next steps to prevent complications in future pregnancies.

What is the most appropriate postnatal management for this patient?

A 30-year-old woman, G1P0, at 37 weeks of gestation presents to the labour ward with severe back pain, vaginal bleeding, and uterine contractions. She reports a recent fall. On examination, her abdomen is rigid and tender. The fetal heart rate is non-reassuring.

What is the most appropriate initial management for this patient?

A 35-year-old woman with a history of bipolar disorder is in her third trimester. Her obstetrician discusses the risk of puerperal psychosis and the importance of early screening and monitoring after delivery.

Which of the following strategies is most appropriate for screening and early detection of puerperal psychosis in this patient?

A 30-year-old woman, G2P2, presents to the maternity ward with a fever of 38.5°C five days postpartum. She had a normal vaginal delivery. Her primary complaints include lower abdominal pain and foul-smelling lochia. On examination, her uterus is tender, and her vital signs indicate tachycardia with a heart rate of 110 bpm.

What is the most likely diagnosis?

A 64-year-old woman presents with a long-standing vulvar lesion that has not responded to topical treatments. The lesion is ulcerated and irregular, with raised edges. She reports associated itching and mild pain.

Which investigation is most appropriate to confirm the diagnosis of vulval carcinoma?

A 45-year-old woman asks her GP about safe alcohol consumption levels. She enjoys drinking wine and is unsure how many units are considered safe per week.

According to UK guidelines, what is the recommended maximum weekly alcohol intake to reduce health risks?

A 40-year-old man presents to the emergency department with a 24-hour history of tremors, sweating, and anxiety after abruptly stopping heavy alcohol use. He reports drinking heavily for the past 10 years and has experienced similar symptoms during previous attempts to quit. On examination, he is tachycardic and diaphoretic.

Which of the following clinical features is most commonly associated with alcohol withdrawal?

A 28-year-old man reports having recurrent, intrusive thoughts about harming his family, despite knowing he would never act on them. These thoughts cause him significant distress, and he spends hours each day trying to suppress them.

Which aspect of obsessive-compulsive disorder is primarily described in this vignette?

A 45-year-old male patient with treatment-resistant depression is scheduled for electroconvulsive therapy (ECT). He is curious about how ECT works and asks the psychiatrist to explain its mechanism.

Which of the following best describes the mechanism of action of electroconvulsive therapy (ECT)?

A 35-year-old woman presents to her GP with persistent worries about having a serious illness despite having no significant symptoms and multiple medical evaluations that have shown no evidence of disease. She frequently checks her body for signs of illness and seeks reassurance from doctors but remains unconvinced that she is healthy.

What is the most likely diagnosis?

A 40-year-old woman with a diagnosis of seasonal affective disorder (SAD) presents for follow-up. She reports that her depressive symptoms, including fatigue and increased appetite, have returned this winter despite using light therapy for 30 minutes each morning. She seeks additional treatment options to manage her symptoms.

Which of the following is the most appropriate next step in the management of this patient’s SAD?

A 2-year-old girl presents with recurrent urinary tract infections. The healthcare provider suspects vesicoureteric reflux (VUR) and considers diagnostic tests to confirm the diagnosis and assess the condition.

Which of the following investigations is most appropriate for confirming the diagnosis of vesicoureteric reflux?

A 65-year-old male with a history of smoking and hypertension presents to the clinic with a painful ulcer on his right foot. The ulcer is located on the lateral malleolus, appears deep with well-defined edges, and has a punched-out appearance. The surrounding skin is shiny and pale, and the foot feels cool to touch. He reports that the pain worsens at night and when the leg is elevated.

Which of the following is the most appropriate initial investigation to confirm the diagnosis of an arterial ulcer?

A 68-year-old woman presents with an itchy lesion on her back that has been present for several years. The lesion is brown, raised, and has a waxy surface. Examination reveals a 2 cm lesion with a stuck-on appearance and some superficial scaling.

Which of the following conditions is commonly associated with multiple seborrhoeic keratoses that appear suddenly?

A 70-year-old man presents with a painful rash on the left side of his face, including his forehead and upper eyelid. The rash started three days ago, and he reports severe pain and sensitivity in the affected area. Examination reveals multiple vesicles on an erythematous base in the distribution of the ophthalmic branch of the trigeminal nerve.

Which complication is most concerning in this patient?

A 50-year-old man with a history of HIV presents with a painful rash and mucosal ulcers. He was started on nevirapine three weeks ago. Physical examination reveals widespread erythematous and purpuric macules, some with blister formation, involving less than 10% of his body surface area. There are also extensive oral and genital mucosal erosions.

What laboratory finding is commonly associated with Stevens-Johnson syndrome?

A 5-year-old child with atopic eczema presents with inflamed, itchy patches on the flexures of her elbows and knees. The GP recommends a topical steroid for treating flare-ups but wants to use an appropriate potency for the affected areas.

Which topical steroid potency is most appropriate for use in this child’s flexural eczema?

A 45-year-old man presents with violaceous lesions on his lower limbs and oral mucosa. He is newly diagnosed with HIV and has a low CD4 count. The dermatologist suspects Kaposi’s sarcoma.

Which factor is most strongly associated with the development of Kaposi’s sarcoma?

A 45-year-old man presents with a rapidly growing, dome-shaped lesion on his right forearm. The lesion has a central keratin-filled crater and has appeared over the last few weeks. He is concerned about the rapid growth, but it is not painful.

What is the most typical clinical course of this lesion?

A 52-year-old woman with estrogen-receptor positive breast cancer is prescribed tamoxifen 20 mg daily to reduce the risk of cancer recurrence. She has recently been diagnosed with depression and requires antidepressant therapy.

Which of the following antidepressants is contraindicated in this patient due to potential interaction with tamoxifen?