CLINICAL CPS MSRA MOCK PAPER 6 (timed)

A 50-year-old man comes to the emergency department complaining of chest pain that began two days ago. The pain is sharp, worse with deep breaths and lying flat, and improves when sitting forward. He denies any recent respiratory infections. His vitals are stable, but ECG shows diffuse ST-segment elevation and PR-segment depression. His blood tests reveal a mildly elevated white blood cell count and CRP.

What investigation is considered the gold standard for diagnosing pericardial effusion in this patient?

A 60-year-old man presents to the emergency department with severe, crushing chest pain that radiates to his left arm and jaw. The pain started one hour ago and is associated with shortness of breath, nausea, and sweating. He has a history of hypertension, diabetes, and smoking.

What is the most likely diagnosis for this patient’s presentation?

A 64-year-old woman presents to the emergency department with severe chest pain that started 30 minutes ago. The pain is crushing, radiates to her left arm and jaw, and is associated with nausea and sweating. She has a history of hypertension and hyperlipidaemia. On examination, her blood pressure is 160/90 mmHg, heart rate is 95 bpm, and she is visibly diaphoretic. An ECG shows ST-segment elevation in leads V1-V4.

What is the most appropriate immediate management for this patient?

A 62-year-old man is diagnosed with non-ST-elevation myocardial infarction (NSTEMI). The healthcare provider discusses potential risk factors with him to help understand why he developed this condition.

Which of the following is a significant risk factor for developing non-ST-elevation myocardial infarction?

A 68-year-old male presents to the emergency department with sudden onset of severe chest pain radiating to his back. He describes the pain as tearing in nature. He has a history of hypertension and is a heavy smoker. On examination, his blood pressure is 180/100 mmHg in the right arm and 160/95 mmHg in the left arm. A new diastolic murmur is heard on auscultation. ECG shows no signs of myocardial infarction.

What is the most appropriate initial imaging modality for diagnosing aortic dissection?

A 62-year-old woman is diagnosed with stable angina. The healthcare provider discusses potential risk factors with her to help understand why she developed this condition.

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

A 25-year-old female presents to the emergency department with worsening shortness of breath and wheezing. She reports a history of asthma since childhood and has been using her salbutamol inhaler frequently over the past week without significant relief. On examination, she is tachypnoeic with an audible expiratory wheeze. Her oxygen saturation is 92% on room air.

What is the next best step in the management of this patient’s acute asthma exacerbation?

A 75-year-old man diagnosed with asbestosis presents with persistent cough and dyspnea. His physician discusses the management plan.

What is the most appropriate treatment approach for asbestosis?

A 55-year-old male presents to the rheumatology clinic with a history of recurrent sinusitis, bloody nasal discharge, and progressive hearing loss over the past few months. He also reports joint pain and hemoptysis. On examination, there are saddle-nose deformity, bilateral purulent nasal discharge, and decreased breath sounds at the lung bases. Ophthalmologic examination reveals scleritis.

Which of the following laboratory findings is most characteristic of granulomatosis with polyangiitis (Wegener’s granulomatosis)?

A 26-year-old man presents with intermittent wheezing, chest tightness, and dyspnea that are triggered by exercise and exposure to cold air. He uses an over-the-counter inhaler with some relief. Physical examination is unremarkable.

Which diagnostic test is most appropriate to confirm exercise-induced asthma?

A 65-year-old male presents to the respiratory clinic with progressive dyspnoea and dry cough over the past month. He reports a history of smoking and recent weight loss. On examination, there is dullness to percussion and decreased breath sounds over the right lung base. Chest X-ray shows blunting of the right costophrenic angle with a meniscus sign.

Which of the following investigations is most appropriate for characterizing the nature of the pleural effusion in this patient?

An 8-year-old girl with moderate persistent asthma is on a low-dose inhaled corticosteroid (ICS) and uses a short-acting beta-agonist (SABA) as needed. She presents for a routine follow-up visit and reports no recent exacerbations but occasional nighttime cough.

Which parameter is most important to monitor regularly in this child with asthma?

A 32-year-old woman presents to the clinic with severe pain during and after bowel movements for the past month. She describes the pain as sharp and lasting for several hours post-defecation. She also reports noticing a small amount of bright red blood on the toilet paper. On examination, there is a small tear in the posterior midline of the anal canal.

What is the most likely diagnosis?

A 55-year-old man with newly diagnosed achalasia presents with severe dysphagia and regurgitation. He is discussing treatment options with his clinician.

Which of the following is the recommended initial management for achalasia?

A 45-year-old woman presents to the emergency department with a 12-hour history of severe right upper quadrant abdominal pain. The pain is constant, radiates to her right shoulder, and is associated with nausea and vomiting. She has had similar, less severe episodes in the past. On examination, she is afebrile, but there is tenderness in the right upper quadrant and a positive Murphy’s sign. Her observations are: heart rate 88 bpm, respiratory rate 16 breaths per minute, blood pressure 120/75 mmHg, and temperature 37.2°3. Laboratory tests reveal mild leukocytosis and normal liver function tests. An ultrasound shows multiple gallstones and a thickened gallbladder wall.

What is the most likely diagnosis?

A 70-year-old woman with a history of heart failure and recent myocardial infarction presents with severe abdominal pain, bloody diarrhea, and elevated lactate levels.

Which of the following is a common cause of acute mesenteric ischaemia?

A 40-year-old female with Crohn’s disease is being reviewed in the gastroenterology clinic. She is currently on azathioprine and reports stable symptoms but is concerned about long-term side effects.

What is a major long-term side effect of azathioprine that needs regular monitoring?

A 65-year-old woman presents with severe epigastric pain and hematemesis. She has a history of long-term NSAID use for osteoarthritis.

Which of the following is the most likely cause of her acute upper gastrointestinal bleeding?

A 14-year-old girl presents to the emergency department with a 2-week history of polyuria, polydipsia, weight loss, and fatigue. On examination, she appears dehydrated, with dry mucous membranes. Blood glucose is measured at 22 mmol/12.

What is the most likely diagnosis?

A 35-year-old woman presents with symptoms suggestive of Graves’ disease. The clinician orders diagnostic tests to confirm the diagnosis.

Which of the following is the most appropriate initial investigation for diagnosing Graves’ disease?

A 17-year-old male presents to his GP with a 6-month history of bilateral breast enlargement. He denies any pain or discharge from the nipples. He has no significant past medical history and is not on any medications. On examination, there is palpable glandular tissue under both nipples.

What is the most likely diagnosis?

A 45-year-old woman presents with symptoms suggestive of hypoparathyroidism. The clinician orders diagnostic tests to confirm the diagnosis.

Which of the following is the most appropriate initial investigation for diagnosing hypoparathyroidism?

A 28-year-old woman presents with amenorrhoea for the past 8 months and milky discharge from her breasts. She also reports headaches and visual disturbances. Blood tests reveal elevated serum prolactin levels.

What is the most likely diagnosis?

A 30-year-old man presents with symptoms of small testes, gynecomastia, and reduced facial hair. The clinician suspects Klinefelter’s syndrome.

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

A 65-year-old male presents to his GP with painless hematuria for the past two weeks. He has a 40-pack-year smoking history but denies any other significant medical history. On examination, there are no palpable masses or tenderness in the abdomen.

What is the most appropriate initial investigation to confirm the diagnosis of bladder cancer?

A 70-year-old man with AKI is concerned about his prognosis. The clinician discusses the factors that influence the prognosis of AKI.

Which of the following factors is most likely to influence the prognosis of acute kidney injury (AKI)?

A 60-year-old male presents with painless hematuria, weight loss, and intermittent flank pain for the past three months. He denies any history of urinary tract infections or trauma. On examination, there is a palpable mass in the right flank. Laboratory tests reveal hemoglobin of 10 g/dL and elevated erythrocyte sedimentation rate (ESR).

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

A 45-year-old man with a history of glomerulonephritis presents with worsening renal function and edema. The clinician discusses potential complications of glomerulonephritis.

Which of the following is a common complication of glomerulonephritis?

A 10-year-old boy presents to the paediatric clinic with dark-coloured urine, facial puffiness, and fatigue. His mother reports that he had a sore throat about two weeks ago. On examination, his blood pressure is 130/85 mmHg, and he has periorbital oedema. Urinalysis shows hematuria, proteinuria, and red blood cell casts. Blood tests reveal an elevated anti-streptolysin O (ASO) titre and reduced C3 complement levels.

What is the most likely diagnosis?

A 30-year-old man with recurrent cystine stones is seeking advice on management options. The clinician discusses the key aspects of managing cystine stones.

Which of the following is a key aspect of managing cystine stones?

A 45-year-old male presents to the clinic with fatigue, weight loss, and early satiety. On physical examination, he has splenomegaly but no lymphadenopathy. Laboratory tests reveal a white blood cell count of 100,000/µL with a differential showing a high number of granulocytes at various stages of maturation. Hemoglobin is 12 g/dL, and platelet count is 450,000/µL. A peripheral blood smear shows a left shift with increased basophils and eosinophils. Cytogenetic analysis reveals the presence of the Philadelphia chromosome (t(9;22)).

What is the most likely diagnosis?

A 35-year-old woman presents with easy bruising, petechiae, and prolonged bleeding after minor cuts. Laboratory tests reveal isolated thrombocytopenia with a platelet count of 20,000/µL and no other abnormalities.

What is the most likely diagnosis for this patient?

A 24-year-old male presents to the GP with symptoms of fatigue, pallor, and mild jaundice. He has a history of intermittent episodes of similar symptoms since childhood. Physical examination reveals mild splenomegaly. His mother has a history of gallstones. Blood tests show a haemoglobin level of 110 g/L, mean corpuscular haemoglobin concentration (MCHC) of 36 g/dL, and reticulocyte count of 7%.

What is the most likely diagnosis?

A 75-year-old man with known MGUS presents with new onset bone pain and fatigue. Laboratory tests reveal hypercalcaemia and an elevated serum creatinine.

Which of the following is a known complication of MGUS that indicates progression to a more serious condition?

A 65-year-old man presents with fatigue, bone pain, and frequent infections. On examination, he has pallor and tenderness over the lower back. Blood tests reveal haemoglobin of 9 g/dL, serum calcium of 3.0 mmol/L, and creatinine of 150 µmol/12. Serum protein electrophoresis shows an M-protein spike.

What is the most appropriate next step in diagnosing multiple myeloma?

A 65-year-old man with known polycythaemia vera presents with sudden onset of chest pain and shortness of breath. Laboratory tests show an elevated haematocrit and leukocytosis.

Which of the following is a known complication of polycythaemia vera?

A 34-year-old man presents to the emergency department with a 3-day history of progressive weakness in his legs, which has now started to involve his arms. He also reports numbness and tingling in his feet and hands. He had an upper respiratory infection about two weeks ago. On examination, he has reduced reflexes and bilateral symmetric weakness in all limbs.

What is the most likely diagnosis?

A 70-year-old man presents with difficulty understanding spoken language. He speaks fluently, but his sentences are nonsensical, and he appears unaware of his language deficits. He recently had a stroke involving the posterior part of the left hemisphere.

Which type of aphasia is most consistent with these clinical features?

An 82-year-old woman with a history of atrial fibrillation and previous strokes presents with worsening cognitive decline over the past two years. Her family notes that she has become increasingly forgetful and has trouble managing her medications. She has also had several episodes of transient confusion. On examination, she has an irregular pulse and a left-sided hemiparesis. A recent CT scan of the brain shows multiple areas of infarction.

Which of the following is the most appropriate initial management for her condition?

A 57-year-old woman presents with progressive personality changes, including loss of empathy and socially inappropriate behavior. Neuroimaging reveals frontal and temporal lobe atrophy. The clinician discusses the underlying pathophysiology of frontotemporal dementia with the patient’s family.

Which of the following proteins is most commonly associated with the neurodegenerative process in frontotemporal dementia?

A 52-year-old woman presents to the emergency department with a sudden, severe headache described as the “worst headache of her life.” She also reports nausea, vomiting, and photophobia. Her past medical history is unremarkable. On examination, she is alert but in severe pain. Her neck is stiff, and she has a positive Kernig’s sign. Her vital signs are: BP 160/100 mmHg, HR 90 bpm, RR 18 breaths per minute.

What is the most appropriate initial investigation?

A 42-year-old woman presents with progressive weakness starting in her lower limbs and ascending to involve her upper limbs. She has difficulty walking and complains of tingling in her hands and feet. On examination, she has absent reflexes in the lower limbs. The clinician suspects Guillain-Barré Syndrome (GBS).

Which of the following clinical features is most characteristic of Guillain-Barré Syndrome?

A 50-year-old man with a history of chronic lymphedema presents with worsening redness, swelling, and pain in his left leg. He was diagnosed with cellulitis two weeks ago but did not complete his antibiotic course. On examination, there is increased erythema and tenderness with some areas of skin breakdown and ulceration.

Which of the following is a potential complication of untreated cellulitis?

A 70-year-old man with a history of frequent hospitalizations is diagnosed with pneumonia. Sputum culture reveals Klebsiella pneumoniae producing extended-spectrum beta-lactamase (ESBL).

Which of the following is the most appropriate antibiotic therapy for ESBL-producing Klebsiella pneumoniae?

A 20-year-old college student presents to the health clinic with swelling of the parotid glands, fever, and headache. He reports that several of his classmates have similar symptoms. Physical examination confirms bilateral parotid gland enlargement. His MMR vaccination status is unknown.

What is the most appropriate initial management for this patient?

A 25-year-old man presents with abdominal cramps and diarrhea after consuming undercooked poultry. He is diagnosed with Campylobacter infection.

Which of the following best describes the pathophysiology of Campylobacter infection?

A 60-year-old man with a recent diagnosis of African trypanosomiasis develops severe headache, high fever, and seizures despite starting treatment. He is admitted to the hospital with signs of encephalopathy.

What is a serious complication of African trypanosomiasis?

A 68-year-old man presents with severe diarrhea and abdominal pain after being hospitalized for a respiratory infection. The physician orders diagnostic tests to confirm Clostridium difficile infection.

Which of the following diagnostic tests is most appropriate for confirming Clostridium difficile infection?

A 45-year-old woman presents with elbow pain and difficulty extending her wrist after a fall. On examination, there is swelling and tenderness over the lateral aspect of the elbow, and she is unable to extend her wrist against resistance.

Which nerve is most likely injured?

A 60-year-old woman is diagnosed with a DVT in her left leg. She presents with calf pain, swelling, and erythema. Doppler ultrasound confirms the presence of a thrombus in the left popliteal vein. She is otherwise healthy with no significant past medical history.

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

A 55-year-old woman with known Sjogren’s syndrome presents with increased fatigue and new-onset swelling of the parotid glands. She also reports worsening dry mouth and difficulty swallowing. On examination, there is bilateral enlargement of the parotid glands without tenderness. Laboratory tests show elevated ESR and hypergammaglobulinemia.

What is the most appropriate next step in evaluating this patient’s condition?

A 70-year-old woman presents with generalized weakness, bone pain, and frequent infections. She has a history of monoclonal gammopathy of undetermined significance (MGUS) diagnosed two years ago. On examination, there is tenderness over multiple bony areas.

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

A 45-year-old woman presents with new-onset hypertension, abdominal pain, and weight loss. She reports episodes of postprandial abdominal pain and has noticed a purplish discoloration on her lower legs. On physical examination, there is livedo reticularis on the lower extremities and tenderness over the abdomen. Laboratory findings include elevated ESR, CRP, and positive hepatitis B surface antigen (HBsAg). Angiography reveals multiple aneurysms and stenoses in the renal and mesenteric arteries.

Which condition is most likely associated with polyarteritis nodosa in this patient?

A 45-year-old man presents with knee pain and swelling after squatting down to lift a heavy object at work. He reports a history of previous knee injuries from playing football in his youth. On examination, there is tenderness along the medial joint line and a positive Thessaly test at 20 degrees of knee flexion.

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

A 40-year-old woman presents to the clinic with sudden onset of left-sided facial weakness. She noticed it while brushing her teeth this morning and found that she couldn’t close her left eye or smile on the left side. She denies any recent trauma or illness but recalls having a cold sore a week ago. On examination, there is complete left-sided facial paralysis, including the inability to raise her left eyebrow. Sensation is intact, and there are no other neurological deficits.

What is the most likely diagnosis?

A 40-year-old woman presents with symptoms of a sore throat, nasal congestion, and a non-productive cough for the past four days. She is seeking advice on how to manage her symptoms at home. Her examination is unremarkable, and she has no signs of bacterial infection.

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

A 45-year-old woman presents with a painless lump in her neck that she noticed two months ago. She denies any difficulty swallowing, voice changes, or symptoms of hyperthyroidism or hypothyroidism. Her medical history is unremarkable. Physical examination reveals a 2 cm firm, non-tender nodule in the right lobe of the thyroid gland. Thyroid function tests are within normal limits.

What is the most appropriate initial diagnostic test for this patient?

A 70-year-old man diagnosed with Ramsay Hunt syndrome presents with severe ear pain, facial paralysis, and hearing loss. The vesicular rash has started to crust over. He is seeking treatment to alleviate his symptoms and prevent further complications.

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

A 30-year-old man presents to the A&E with a 5-day history of severe sore throat, difficulty swallowing, and a muffled voice. He reports fever and chills but denies any cough. On examination, his temperature is 39.0°C, his tonsils are markedly swollen with pus, and there is tender cervical lymphadenopathy. His uvula is deviated to the right.

What is the most likely complication this patient is experiencing?

A 72-year-old woman with a history of untreated pharyngeal pouch presents with severe chest pain and difficulty breathing. She reports a sudden onset of symptoms after eating a large meal. Examination reveals signs of sepsis, and imaging shows mediastinal air and fluid collection.

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

A 28-year-old woman presents to her GP with a complaint of a red, painful left eye for the past 2 days. She reports mild photophobia and a gritty sensation but denies any visual changes or discharge. On examination, there is conjunctival injection and a small corneal abrasion but no foreign body.

What is the most likely cause of this patient’s red eye?

A 6-year-old girl is referred to the ophthalmology clinic because her teacher noticed that she frequently squints and has difficulty reading the board in class. Her parents report that she often tilts her head when looking at distant objects. On examination, a right eye exotropia (outward turning of the eye) is noted.

Which investigation is most appropriate to assess the severity and impact of her squint?

A 40-year-old woman presents with a recurrent painful bump on her upper eyelid. She has had similar episodes in the past, which resolved with conservative treatment. She now has a tender, red nodule at the base of her upper eyelid. She denies any vision changes or systemic symptoms.

What underlying condition might predispose her to recurrent styes?

A 30-year-old man presents to the neurology clinic with complaints of persistent headaches, nausea, and episodes of blurred vision over the past month. Neurological examination reveals bilateral papilloedema on fundoscopy. The clinician decides to further investigate the cause of the raised intracranial pressure.

Which investigation is most appropriate to determine the cause of the papilloedema?

A 45-year-old man presents with worsening headaches, visual disturbances, and occasional vomiting over the past few weeks. He has a history of hypertension. Fundoscopic examination reveals bilateral optic disc swelling with hemorrhages and cotton-wool spots.

Which imaging study is most appropriate to investigate the cause of papilloedema?

A 55-year-old man with a history of uncontrolled hypertension presents to the ophthalmology clinic with complaints of gradual blurring of vision in both eyes. He denies any pain or other systemic symptoms. On fundoscopic examination, there are flame-shaped hemorrhages, cotton-wool spots, and arteriovenous nicking.

What is the most appropriate initial investigation to confirm the diagnosis of hypertensive retinopathy?

A 9-year-old boy is brought to the paediatric clinic by his parents due to concerns about his behavior at school. His teachers report that he is often inattentive, easily distracted, and has difficulty completing tasks. At home, his parents notice that he is very active, talks excessively, and has trouble sitting still even during meals. These behaviours have been present for over six months and are affecting his academic performance and social interactions.

What is the most appropriate initial diagnostic approach for this child?

A 2-year-old boy is diagnosed with an undescended testis. The healthcare provider discusses potential risk factors with the parents to help them understand why their child developed this condition.

Which of the following is a significant risk factor for developing an undescended testis?

A 1-day-old male infant is diagnosed with congenital diaphragmatic hernia after presenting with respiratory distress and being stabilized on mechanical ventilation. An echocardiogram is performed to evaluate the cardiac status.

Which of the following cardiac findings is commonly associated with congenital diaphragmatic hernia?

A 9-month-old infant presents with a persistent, greasy, scaly rash on the scalp and face. The healthcare provider suspects seborrhoeic dermatitis and considers diagnostic tests to confirm the diagnosis and rule out other conditions.

Which of the following investigations is most appropriate for confirming the diagnosis of seborrhoeic dermatitis in children?

A 6-year-old girl with a known diagnosis of cystic fibrosis presents to the clinic with increased cough, sputum production, and shortness of breath. She has had similar episodes in the past, usually treated with antibiotics. Physical examination reveals crackles and wheezes in the lungs.

What is the most likely cause of the exacerbation in this patient?

A 7-year-old boy diagnosed with nephrotic syndrome presents for a management plan. The healthcare provider discusses various treatment options with the parents.

What is the most appropriate initial management for a child with nephrotic syndrome?

A 60-year-old postmenopausal woman presents to her GP with complaints of vaginal bleeding. She experienced menopause at age 52 and has had no bleeding until now. She has a history of obesity and hypertension. Physical examination reveals no abnormalities.

What is the most appropriate initial investigation to evaluate her symptoms?

A 33-year-old woman, currently at 42 weeks gestation, is being counselled about the potential fetal risks associated with post-term pregnancy. She is worried about the well-being of her baby and wants to understand the risks better.

Which of the following is a significant fetal risk associated with post-term pregnancy?

A 32-year-old woman and her 34-year-old partner present to their GP with concerns about infertility. They have been trying to conceive for 18 months without success. Both partners are healthy with no significant medical history. The woman has regular menstrual cycles, and the couple reports regular intercourse.

Which of the following is the most appropriate initial investigation for this couple?

A 29-year-old woman, ten days postpartum, presents with tearfulness, mood swings, and irritability. She is worried because her symptoms have not improved and she feels increasingly disconnected from her baby.

Which factor differentiates baby blues from post-partum depression?

A 32-year-old woman, G2P2, delivered a healthy baby vaginally 2 hours ago. She is now experiencing heavy vaginal bleeding. Her vitals are: Blood Pressure 90/60 mmHg, Heart Rate 110 bpm, Respiratory Rate 20 breaths per minute, and Temperature 36.8°3. On examination, the uterus is boggy and not well contracted.

What is the first-line management for this patient?

A 35-year-old woman presents with a history of three consecutive miscarriages, all occurring within the first trimester. She has no living children and is otherwise healthy. Her past medical history is unremarkable, and she does not smoke or drink alcohol.

Which of the following is a common cause of recurrent miscarriage?

A 19-year-old woman presents to the GP with complaints of significant weight loss, amenorrhea for the past 4 months, and an intense fear of gaining weight. She reports restricting her calorie intake to less than 500 calories per day and exercises excessively.

What is the most likely diagnosis?

A 16-year-old girl presents with significant weight loss, fear of gaining weight, and restrictive eating behaviors. Her mother reports that she has always been a perfectionist and highly critical of her body image. The girl also spends a lot of time on social media, comparing herself to others.

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

A 45-year-old woman with schizoaffective disorder presents with severe depressive symptoms and persistent auditory hallucinations. She is currently not on any medication and her symptoms are significantly impairing her daily functioning.

What is the most appropriate initial management for this patient?

A 50-year-old woman with a history of Bipolar I disorder is brought to the emergency department by her family. She is experiencing a severe manic episode, marked by delusions of grandeur, reckless driving, and impulsive spending. Her family is worried about her safety and ability to manage daily tasks.

Which of the following is a potential complication associated with untreated mania?

A 45-year-old man presents to the GP with complaints of persistent sadness, fatigue, and difficulty concentrating over the past two months. He has a history of major depressive disorder and is currently experiencing increased stress at work. The GP decides to perform a mental state examination (MSE) to assess his current mental state.

Which of the following is NOT typically assessed during a mental state examination?

A 30-year-old female presents to her GP with multiple physical complaints, including chronic headaches, abdominal pain, and joint pain. She has seen several specialists over the past five years, undergone numerous tests, and tried various treatments, but no clear medical cause has been identified. She expresses frustration and significant distress about her symptoms, which have impacted her daily functioning and quality of life.

Which of the following symptoms is most indicative of somatisation disorder?

A 9-month-old infant presents with a sudden onset of high fever that lasted for three days, followed by the appearance of a maculopapular rash on the trunk. The healthcare provider suspects roseola infantum and considers diagnostic tests to confirm the diagnosis.

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

A 45-year-old male with granuloma annulare presents with new, rapidly enlarging lesions that are causing him concern. The lesions are more widespread and have started to merge.

What is the most likely complication of granuloma annulare in this patient?

A 50-year-old man presents with a history of redness and visible blood vessels on his nose and cheeks. He mentions that his skin tends to be more sensitive and easily irritated. He denies any use of new skincare products. Examination reveals telangiectasia on the nose and cheeks, with some erythema but no pustules or papules.

Which subtype of rosacea is most consistent with this presentation?

A 25-year-old woman presents with an intensely itchy rash that has spread over her body. She mentions that the itching worsens at night and her roommate is experiencing similar symptoms. Examination reveals numerous small papules and vesicles on her wrists, finger webs, and around her waist.

Which of the following is a common complication of untreated scabies?

A 40-year-old woman presents with a recurrent lump on her back. She had a similar lump removed a year ago, but it has reappeared. On examination, there is a 2 cm, firm, subcutaneous nodule with a central punctum in the same location as the previous excision.

What is the most likely reason for the recurrence of the sebaceous cyst?

A 50-year-old woman presents with multiple round, coin-shaped lesions on her lower legs. The lesions are erythematous, scaly, and intensely itchy. She has a history of atopic eczema. The dermatologist considers a differential diagnosis.

Which of the following conditions should be considered in the differential diagnosis?

A 55-year-old man presents with multiple violaceous macules and plaques on his lower extremities. He is known to be HIV positive. Some lesions have ulcerated, and there is associated lymphoedema.

Which condition should be the primary differential diagnosis?

A 68-year-old man with a history of sun-damaged skin presents with a rapidly growing, ulcerated lesion on his scalp. He also has palpable cervical lymphadenopathy. The lesion was biopsied and confirmed as cutaneous squamous cell carcinoma.

What is the most significant prognostic factor in this case?

A 32-year-old woman presents with pelvic pain and heavy menstrual bleeding. She has been diagnosed with endometriosis based on laparoscopy and has been referred for management of her symptoms. She has no desire for pregnancy at this time.

Which of the following medications is commonly used for the treatment of endometriosis and has anti-oestrogenic effects?

A 64-year-old male is attending his annual medication review. He has a history of peripheral arterial disease and hypertension. He is currently taking the following medications:
* Clopidogrel 75 mg once daily
* Amlodipine 5 mg once daily
* Ramipril 10 mg once daily
* Diclofenac 50 mg PRN for joint pain
On review, you decide that one of his medications is contraindicated in the context of his cardiovascular risk.

Which of the following medications should be discontinued or replaced?

A 72-year-old woman with a history of hypertension and hyperlipidaemia sustains a wrist fracture and is started on regular pain relief with a non-steroidal anti-inflammatory drug (NSAID). Four weeks later, she develops central chest pain, sweating, and shortness of breath. An ECG confirms a myocardial infarction.

Which analgesic is most likely to have caused this cardiovascular event?