CLINICAL CPS MSRA MOCK PAPER 7 (untimed) – answers immediately

A 35-year-old woman presents with severe chest pain that has been worsening over the past 24 hours. The pain is sharp, exacerbated by inspiration, and relieved by sitting up. She has no significant past medical history. On examination, her temperature is 37.8°C, heart rate is 110 bpm, and there is a pericardial friction rub. An ECG shows diffuse ST-segment elevation. Blood tests reveal an elevated CRP and ESR.

Which of the following is a potential complication of acute pericarditis?

A 55-year-old woman is diagnosed with myocardial infarction (MI). 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 myocardial infarction?

A 58-year-old man presents to the emergency department with chest pain that started two hours ago. The pain is central, pressure-like, and radiates to his left shoulder. He has a history of diabetes and smokes 20 cigarettes a day. On examination, his blood pressure is 145/85 mmHg, heart rate is 85 bpm, and ECG shows ST-segment depression in leads II, III, and aVF. Blood tests show elevated troponin levels.

What is the most appropriate next step in managing this patient?

A 68-year-old woman presents with chest pain suggestive of non-ST-elevation myocardial infarction. 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 non-ST-elevation myocardial infarction?

A 55-year-old woman presents with sudden onset of severe chest and back pain. She has a history of Marfan syndrome. On examination, her blood pressure is 190/110 mmHg, and there is a difference in blood pressure between the arms. She also has weak peripheral pulses. A chest X-ray shows a widened mediastinum.

What is the most appropriate initial pharmacological management for this patient?

A 65-year-old man presents with chest pain suggestive of stable angina. 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 stable angina?

A 32-year-old male presents to his general practitioner with a persistent cough and sputum production for the past week. He denies any fever or dyspnoea but complains of fatigue. He reports a history of smoking ten cigarettes per day for the past ten years. On examination, there are scattered rhonchi on auscultation of the chest, but no signs of consolidation or wheezing. Vital signs are within normal limits.

Which of the following investigations is most appropriate for confirming the diagnosis of acute bronchitis in this patient?

A 70-year-old retired insulation worker with a history of asbestosis is being monitored for disease progression.

Which parameter is most important to monitor regularly in patients with asbestosis?

A 60-year-old female presents to the rheumatology clinic with a 2-month history of worsening fatigue, arthralgia, and myalgia. She also reports hematuria and proteinuria. On examination, there are bilateral lower extremity purpura and tenderness over the joints. Urinalysis reveals red blood cell casts.

Which of the following findings on renal biopsy is most characteristic of microscopic polyangiitis?

A 32-year-old woman with a history of mild persistent asthma presents with increased symptoms, including wheezing and shortness of breath twice a week and night-time awakenings twice a month. She is currently using a short-acting beta-agonist (SABA) as needed.

What is the most appropriate step-up therapy for this patient?

A 50-year-old otherwise healthy female presents to the emergency department with a 5-day history of fever, productive cough with yellowish sputum, pleuritic chest pain, and dyspnoea. She denies recent travel but reports close contact with family members who had similar symptoms. On examination, her temperature is 38.9°C (102°F), respiratory rate is 24 breaths per minute, and there are crackles heard on auscultation of the right lower lung zone. Chest X-ray shows patchy consolidation in the right lower lobe.

Which of the following organisms is the most likely causative agent of pneumonia 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 68-year-old woman presents to the clinic with intermittent episodes of painless gastrointestinal bleeding over the past few months. She reports noticing dark, tarry stools and occasionally bright red blood per rectum. She has a history of chronic kidney disease and hypertension. On examination, her vital signs are stable, but fecal occult blood test is positive.

What is the most likely diagnosis?

A 50-year-old man presents with dysphagia, chest pain, and significant weight loss. A barium swallow study is performed to evaluate his symptoms.

Which of the following imaging findings is most consistent with a diagnosis of achalasia?

A 55-year-old woman presents to the emergency department with a 24-hour history of severe right upper quadrant pain, fever, and nausea. The pain is constant, radiates to her right shoulder, and worsens with deep breaths. She has a history of gallstones but no prior episodes of similar pain. On examination, she has a positive Murphy’s sign and tenderness in the right upper quadrant. Her observations are: heart rate 95 bpm, respiratory rate 20 breaths per minute, blood pressure 130/85 mmHg, and temperature 38.0°3. Laboratory tests reveal leukocytosis and mildly elevated liver enzymes. An ultrasound shows gallstones, a thickened gallbladder wall, and pericholecystic fluid.

What is the most likely diagnosis?

A 60-year-old man with a history of peripheral artery disease presents with sudden severe abdominal pain and a distended abdomen. He is hypotensive and in shock.

Which of the following is a significant risk factor for developing acute mesenteric ischaemia?

A 27-year-old male with a history of Crohn’s disease presents with joint pain and swelling, particularly in his knees and ankles. He also mentions red, painful eyes and a rash on his legs.

Which extraintestinal manifestation is most likely associated with his condition?

A 58-year-old man with a history of cirrhosis and chronic hepatitis C presents with hematemesis. Physical examination reveals signs of chronic liver disease.

Which of the following diagnostic tests is most appropriate for confirming esophageal varices as the cause of his acute upper gastrointestinal bleeding?

A 55-year-old man presents to his GP with a 3-month history of increased thirst, frequent urination, and fatigue. He has a BMI of 32 kg/m² and a blood pressure of 140/85 mmHg. A random blood glucose test shows a level of 13 mmol/12.

What is the most likely diagnosis?

A 28-year-old man is diagnosed with Graves’ disease. The clinician discusses the initial management plan.

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

A 45-year-old man presents with recent onset of breast enlargement and tenderness. He has been taking spironolactone for hypertension for the past year. Examination reveals bilateral gynaecomastia.

Which of the following is the most likely cause of his gynaecomastia?

A 45-year-old woman with hypoparathyroidism presents with persistent hypocalcaemia despite adequate calcium and vitamin D supplementation. The clinician considers the role of magnesium.

Which of the following best describes the role of magnesium in the management of hypoparathyroidism?

A 45-year-old man with Type 2 diabetes mellitus presents to the emergency department with sweating, palpitations, and confusion. He took his usual dose of insulin this morning but skipped breakfast. His capillary blood glucose is 2.2 mmol/12.

What is the most likely diagnosis?

A 18-year-old man presents with symptoms suggestive of Klinefelter’s syndrome. The clinician orders diagnostic tests to confirm the diagnosis.

Which of the following is the most appropriate initial investigation for diagnosing Klinefelter’s syndrome?

A 30-year-old woman presents to the emergency department with excessive thirst and large volumes of dilute urine. She reports drinking up to 10 litres of water per day. Her past medical history is unremarkable. Physical examination reveals dry mucous membranes. Laboratory results show a serum sodium of 148 mmol/L and a urine osmolality of 90 mOsm/kg.

What is the most appropriate initial investigation to confirm the diagnosis of diabetes insipidus?

A 65-year-old man with a history of poorly controlled diabetes and hypertension is diagnosed with chronic kidney disease (CKD). The clinician discusses the common causes of CKD.

Which of the following are common causes of chronic kidney disease (CKD)?

A 55-year-old female with end-stage renal disease (ESRD) secondary to diabetic nephropathy is evaluated for a renal transplant. She has been on hemodialysis for the past two years. Her medical history includes hypertension and hyperlipidemia. Physical examination is unremarkable. Her current medications include an ACE inhibitor, a statin, and erythropoietin.

Which of the following is an absolute contraindication to renal transplantation?

A 7-year-old boy diagnosed with minimal change disease (MCD) presents with severe edema. The clinician discusses the treatment options.

Which of the following is the most appropriate initial treatment for minimal change disease (MCD) in children?

A 65-year-old male with a history of chronic kidney disease (CKD) stage 3 is scheduled for a contrast-enhanced CT scan of the abdomen. His baseline serum creatinine is 150 µmol/L, and eGFR is 40 mL/min/1.73m². He is asymptomatic and his physical examination is unremarkable.

What is the most appropriate prophylactic measure to reduce the risk of contrast-induced nephropathy in this patient?

A 60-year-old woman with a history of recurrent kidney stones presents with hematuria. The clinician suspects urate stones and orders diagnostic tests.

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

A 55-year-old female presents to the clinic with fatigue, joint pain, and purpura on her lower extremities. She also reports numbness and tingling in her hands and feet. On examination, there are palpable purpuric lesions on her legs and peripheral neuropathy. Laboratory tests show mild anemia, elevated ESR, and positive rheumatoid factor. Serum protein electrophoresis reveals a monoclonal IgM spike. Cryoglobulin test is positive.

What is the most likely underlying condition associated with her cryoglobulinaemia?

A 40-year-old woman presents with easy bruising and petechiae. She has a history of an autoimmune disorder.

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

A 25-year-old man presents to his GP with a 3-month history of painless cervical lymphadenopathy. He reports occasional night sweats, fever, and unexplained weight loss. On examination, there are multiple enlarged, non-tender lymph nodes in the cervical region. His blood tests reveal a normocytic anaemia and an elevated erythrocyte sedimentation rate (ESR).

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

A 3-year-old girl is brought to the clinic with developmental delay and irritability. Her family lives in a house built in the 1950s.

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

A 65-year-old woman presents with fatigue, night sweats, and weight loss over the past 6 months. On examination, she has pallor and splenomegaly extending 6 cm below the left costal margin. Blood tests reveal haemoglobin of 8.5 g/dL, white cell count of 15 x 10^9/L, and platelet count of 450 x 10^9/12. A peripheral blood smear shows teardrop-shaped red blood cells and nucleated red blood cells.

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

A 50-year-old woman presents with leg pain and swelling three months after being diagnosed with a deep vein thrombosis. She was non-compliant with her anticoagulation therapy.

Which of the following is a significant risk factor for developing post-thrombotic syndrome?

A 28-year-old woman presents to the clinic with a 2-year history of recurrent headaches. She describes them as throbbing and unilateral, often associated with nausea, vomiting, and sensitivity to light and sound. These headaches last between 4 to 72 hours and are debilitating, often causing her to miss work. There is no history of head trauma, and her neurological examination is unremarkable.

What is the most appropriate acute treatment for her migraines?

A 5-year-old girl is referred to a genetics clinic due to progressive ataxia, recurrent respiratory infections, and telangiectasias on her eyes and skin. Her parents are concerned as the doctor mentioned that this condition might be inherited.

Which of the following genetic factors is most directly associated with the development of Ataxia Telangiectasia?

A 28-year-old woman presents to the clinic with complaints of muscle stiffness, especially in the morning, and difficulty lifting her arms. She also has a history of cataracts and reports daytime sleepiness. On physical examination, she has frontal baldness, ptosis, and difficulty releasing her grip after squeezing the examiner’s hand. A family history reveals that her mother had similar symptoms.

Which of the following additional investigations is most appropriate to confirm the diagnosis?

A 32-year-old man presents with foot drop after a prolonged period of kneeling while working on a home improvement project. He reports that he is unable to lift his foot or toes and has numbness along the outer side of his calf and foot. The clinician suspects a common peroneal nerve lesion.

Which of the following best describes the pathophysiology underlying a common peroneal nerve lesion?

A 65-year-old woman presents to the emergency department with a worsening headache and confusion over the past week. She had a minor head injury two weeks ago but did not seek medical attention at that time. Her medical history includes hypertension and diabetes. On examination, she is disoriented to time and place, with a GCS score of 12. CT scan of the head shows a hypodense crescent-shaped lesion over the left cerebral hemisphere.

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

A 34-year-old woman presents to the clinic with a 6-month history of recurring headaches. She describes the headaches as throbbing and usually occurring on one side of her head. They are often associated with nausea and sensitivity to light. She reports that the pain lasts several hours and can be debilitating. The clinician considers the different types and causes of headaches.

Which of the following types of headache is most consistent with this patient’s symptoms?

A 40-year-old man presents to the outpatient clinic with progressive weakness in his legs, difficulty walking, and a history of diarrhoea two weeks ago. Neurological examination reveals reduced reflexes and muscle strength in the lower limbs. He mentions that his diarrhoeal illness was diagnosed as Campylobacter infection.

What is the most likely complication of his recent infection?

A 65-year-old woman is being treated for a severe, hospital-acquired Gram-negative infection. The physician decides to include an aminoglycoside in her treatment regimen.

Which of the following infections is most appropriately treated with an aminoglycoside?

A 28-year-old man presents to the sexual health clinic with a 5-day history of dysuria and urethral discharge. He denies any fever or systemic symptoms but reports having unprotected sexual intercourse with a new partner two weeks ago. On examination, there is mild erythema at the urethral meatus and a clear discharge.

What is the most likely causative organism?

A 70-year-old man with severe Campylobacter infection, including high fever, bloody diarrhea, and signs of sepsis, is admitted to the hospital.

Which of the following is the most appropriate indication for initiating antibiotic therapy in Campylobacter infection?

A 70-year-old man with a history of benign prostatic hyperplasia (BPH) presents with fever, chills, and flank pain. He has had symptoms of dysuria and frequency for the past week but did not seek medical attention. On examination, he has costovertebral angle tenderness and is febrile at 38.5°3.

What is a potential serious complication of a urinary tract infection in this patient?

A 32-year-old HIV-positive woman presents with chronic watery diarrhea, abdominal cramps, and weight loss. The physician suspects cryptosporidiosis.

Which of the following is the most characteristic clinical feature of cryptosporidiosis?

A 35-year-old pianist presents with difficulty and pain while playing the piano. The pain is localized to the medial aspect of his forearm, particularly when flexing his wrist. On examination, there is tenderness over the medial epicondyle.

Which muscle is most likely involved in this condition?

A 55-year-old man underwent surgical fasciectomy for Dupuytren’s contracture six months ago. He now presents with stiffness and reduced range of motion in the affected fingers. He also reports numbness and tingling in his hand.

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

A 60-year-old man presents with joint pain, swelling, and morning stiffness that improves with activity. He has noticed similar symptoms in his knees, ankles, and shoulders. On examination, there is symmetrical swelling and tenderness of multiple joints, including the MCP and PIP joints of the hands. Laboratory tests show elevated ESR, CRP, and positive anti-cyclic citrullinated peptide (anti-CCP) antibodies.

Which medication is the most appropriate first-line disease-modifying antirheumatic drug (DMARD) for this condition?

A 5-year-old girl with a history of multiple previous injuries presents with a new, unexplained bruise on her face. Further examination reveals signs of emotional distress and behavioral problems, including anxiety and difficulty sleeping. Her school performance has also declined significantly over the past few months.

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

A 60-year-old woman presents with a fracture of the wrist after a minor fall. She has a history of rheumatoid arthritis and has been on long-term corticosteroid therapy. She is concerned about her bone health. A DEXA scan reveals a T-score of -2.8 in the femoral neck.

What is the most appropriate initial management for this patient?

A 13-year-old overweight boy presents with a several-week history of right hip pain and a limp. He also reports pain in his right knee. On examination, there is external rotation of the right hip and limited internal rotation. An X-ray confirms the diagnosis of slipped capital femoral epiphysis (SCFE).

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

A 60-year-old man presents to the clinic with episodes of dizziness that last less than a minute and are triggered by specific head movements, such as turning over in bed or looking up. He describes the sensation as spinning. There are no other associated symptoms, such as hearing loss, tinnitus, or neurological deficits. Physical examination is unremarkable, but you suspect BPPV.

Which diagnostic maneuver is most appropriate to confirm the diagnosis of BPPV?

A 65-year-old woman with a long-standing history of trigeminal neuralgia presents with worsening pain despite medication. She is also experiencing side effects from her current medication regimen, including dizziness and drowsiness. She is concerned about potential complications of her condition and treatment.

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

A 45-year-old woman presents with a one-month history of hoarseness, throat clearing, and a sensation of a lump in her throat. She denies any smoking history or recent upper respiratory infections. Physical examination is unremarkable.

Which condition is most likely responsible for her symptoms?

A 68-year-old woman presents with difficulty hearing conversations, especially in crowded places. She has no history of ear infections or trauma. She worked as a school teacher for 40 years and has a history of mild hypertension. On examination, her hearing is reduced bilaterally.

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

A 52-year-old woman presents to the emergency department with a painful rash on her right ear and severe vertigo. She reports a two-day history of right-sided facial weakness and difficulty closing her right eye. On examination, there are vesicular lesions in the external auditory canal and pinna of the right ear. She also has right-sided facial paralysis and diminished taste sensation on the anterior two-thirds of the tongue.

What is the most appropriate initial management for this condition?

A 45-year-old man with a history of nasal trauma and untreated nasal septal haematoma presents with severe nasal congestion, fever, and a foul-smelling nasal discharge. Examination reveals an inflamed and tender nasal septum with purulent drainage.

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

A 72-year-old woman with a history of hypertension, diabetes, and hyperlipidemia presents with sudden, painless loss of vision in her left eye. Examination reveals a pale retina and a cherry-red spot at the macula. The patient is not currently on any anticoagulation therapy.

What is the most appropriate initial management for this condition?

A 55-year-old man with a history of chronic dry eye syndrome presents with increased discomfort and redness in his right eye. He reports a sharp pain and sensitivity to light. On examination, there is a small central corneal ulcer with surrounding infiltrates.

Which complication is the most likely cause of his symptoms?

A 45-year-old man presents with a painless swelling on his lower eyelid. He reports that the lump has been there for about a month and has not changed in size recently. Examination reveals a firm, non-tender nodule located away from the lash line, without any surrounding erythema.

What is the most appropriate initial management for this condition?

A 12-year-old girl is diagnosed with orbital cellulitis after presenting with eye pain, fever, and proptosis. A CT scan confirms the diagnosis, showing inflammation of the orbital tissues. She has no known drug allergies and her vital signs are stable.

Which is the most appropriate initial management for this patient?

A 70-year-old man with a history of diabetes and hypertension presents for a follow-up eye exam. He denies any vision problems. His intraocular pressure is 26 mmHg in both eyes. Fundoscopy shows optic nerve cupping with a cup-to-disc ratio of 0.7. Visual field testing reveals peripheral vision loss.

What is the first-line treatment for this condition?

A 30-year-old woman presents to the ophthalmology clinic with complaints of blurred vision in her right eye and difficulty focusing on near objects over the past few months. She denies any pain or other symptoms. On examination, her right pupil is larger than the left and reacts sluggishly to light, but there is a more pronounced response to accommodation. The rest of the neurological examination is unremarkable.

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

A 6-month-old boy is brought to the emergency department by his parents with a three-day history of cough, nasal congestion, and difficulty breathing. His symptoms worsened over the past 24 hours, and he has been feeding poorly. On examination, he is afebrile, has a respiratory rate of 60 breaths per minute, and oxygen saturation of 94% on room air. Auscultation reveals diffuse wheezing and crackles.

What is the most likely causative agent of this condition?

A 6-year-old girl with a history of an umbilical hernia presents for a follow-up visit. The parents are concerned about potential complications associated with the condition if it does not resolve.

Which of the following is a significant complication associated with an untreated umbilical hernia in children?

A 2-day-old male newborn is evaluated in the NICU for cyanosis and difficulty breathing. He was born at term via normal vaginal delivery without complications. On physical examination, there is a systolic murmur heard best at the left upper sternal border and a single second heart sound. An echocardiogram is performed.

What is the most likely diagnosis?

A 6-year-old girl diagnosed with scarlet fever presents for a management plan. The healthcare provider discusses the initial treatment options with the parents.

What is the most appropriate initial management for a child with scarlet fever?

A 1-year-old boy is brought to the paediatric clinic for a routine check-up. On physical examination, the left testis is not palpable in the scrotum or the inguinal canal. The right testis is normally descended. The parents are concerned about the implications and potential need for treatment.

What is the most appropriate initial management for this condition?

A 3-week-old premature infant with a history of necrotising enterocolitis presents for a follow-up visit. The parents are concerned about potential long-term complications associated with the condition.

Which of the following is a significant long-term complication associated with necrotising enterocolitis (NEC)?

A 34-year-old woman presents to the gynecology clinic with a six-month history of infertility. She also reports severe dysmenorrhoea and pain during intercourse. Her menstrual cycles are regular, and she has no other significant medical history. A transvaginal ultrasound performed previously showed an ovarian cyst consistent with an endometrioma.

What is the gold standard for diagnosing endometriosis in this patient?

A 32-year-old woman, gravida 2 para 1, presents for her routine antenatal visit at 41 weeks and 3 days gestation. She reports feeling well and having no contractions or signs of labour. She is concerned about being past her due date.

Which of the following defines a post-term pregnancy?

A 32-year-old woman, G2P1, at 8 weeks of gestation presents to her GP with persistent nausea and vomiting. She has tried dietary changes and over-the-counter remedies without relief. She has mild dehydration on examination but is otherwise stable.

Which of the following medications is the first-line treatment for hyperemesis gravidarum?

A 35-year-old woman at 33 weeks gestation presents with sudden onset of heavy vaginal bleeding and severe abdominal pain. She has a history of hypertension. On examination, her abdomen is tense and tender, and her vital signs show tachycardia and hypotension.

Which of the following is the most critical differential diagnosis to consider?

A 30-year-old woman, 3 weeks postpartum, presents with a painful, swollen area in her right breast. She reports redness and warmth over the affected area, along with a fever of 38.5°3. She is breastfeeding her newborn and notes that the baby has been feeding more from the left breast due to the pain.

What is the most appropriate initial management for this patient?

A 30-year-old woman, seven days postpartum, presents with a fever of 39°C, flank pain, and dysuria. Her delivery was vaginal, and she has a history of recurrent urinary tract infections.

Which condition is most likely causing her fever?

A 29-year-old woman with bipolar disorder is stable on lithium therapy but experiences frequent depressive episodes. She is seeking advice on additional treatment options to manage her depressive symptoms without triggering mania.

Which medication can be added to her regimen to manage depressive episodes in bipolar disorder?

A 30-year-old man presents to the psychiatric clinic with episodes of elevated mood, increased energy, and decreased need for sleep lasting several days. These episodes are followed by periods of severe depression, during which he feels hopeless and loses interest in activities he usually enjoys. His symptoms have caused significant disruption in his work and personal life.

Which of the following clinical features is most commonly associated with bipolar disorder?

A 32-year-old man presents to the GP with complaints of nightmares, flashbacks, and severe anxiety for the past six months after surviving a car accident. He avoids driving and feels constantly on edge, easily startled, and has difficulty sleeping.

What is the most likely diagnosis?

A 50-year-old man presents to the clinic with a history of Bipolar II disorder. He reports recent episodes of hypomania where he has felt more energetic and has engaged in risky behaviors such as excessive spending and gambling. Despite these behaviors, he has not experienced any significant impairment in his daily functioning.

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

A 28-year-old woman presents to her GP with a history of mood swings. Over the past two weeks, she has experienced periods of elevated mood, increased energy, decreased need for sleep, and increased talkativeness. She reports feeling unusually productive but denies engaging in risky behaviours or experiencing significant functional impairment. She has no history of hospitalisation for her symptoms.

What is the most likely diagnosis?

A 40-year-old male presents to his GP with persistent fears of having a serious illness despite repeated reassurances from multiple doctors and numerous normal test results. He frequently checks his body for signs of illness and spends hours each day researching medical conditions online. These fears cause significant anxiety and interfere with his daily activities.

Which of the following symptoms is most indicative of illness anxiety disorder (hypochondriasis)?

A 12-year-old girl is diagnosed with mesenteric adenitis. Her parents are concerned and want to understand the potential risk factors associated with this condition.

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

A 7-year-old boy presents with new onset of red, crusty sores around his nose and mouth. His mother mentions that he has been scratching his eczema lesions on his arms and legs, and he recently had a cold.

Which of the following is the most significant risk factor for developing impetigo in this patient?

A 12-year-old girl is referred to the dermatology clinic with a port wine stain on the left side of her face, involving her eyelid and forehead. Her parents are concerned about potential complications and long-term management options. Neurological examination reveals no abnormalities.

Which syndrome is most commonly associated with port wine stains involving the ophthalmic branch of the trigeminal nerve?

A 35-year-old man presents to the GP with a history of itchy, flaky skin on his scalp, eyebrows, and nasolabial folds for the past three months. He reports that the symptoms worsen during periods of stress. Physical examination reveals erythematous plaques with greasy scales on the scalp, eyebrows, and sides of the nose.

What is the most likely diagnosis?

A 42-year-old woman presents with recurrent episodes of itchy blisters on her hands and feet, occurring every few months. She reports that the blisters usually resolve within 2 weeks but leave the skin dry and cracked. She is otherwise healthy and has tried over-the-counter creams with little relief. On examination, there are healing vesicles and areas of desquamation on her palms and soles.

What is the most appropriate investigation to rule out secondary infection in this patient?

A 4-year-old boy with atopic dermatitis presents with widespread, painful vesicles and erosions on his face and trunk. He is febrile and lethargic. The dermatologist suspects eczema herpeticum and recommends immediate treatment.

What is the most appropriate initial management?

A 60-year-old man presents with a chronic, itchy, erythematous rash that has been worsening over several years. The rash consists of well-demarcated patches and plaques on his trunk and limbs. He has been treated unsuccessfully for eczema.

What is the most likely diagnosis?

An 85-year-old woman with a history of chronic sun exposure presents with a large, irregularly pigmented lesion on her forehead. It has recently become more raised and darkened in some areas. The lesion measures 4 cm and has been slowly changing over the past decade.

What is the most significant risk factor for this type of melanoma?

A 70-year-old man presents with cognitive decline over the last two years. He has recently been diagnosed with moderate Alzheimer’s disease. His symptoms include memory loss, confusion, and difficulty with daily tasks. The family is concerned and would like to start him on treatment to slow the progression of the disease.

Which of the following drugs is the most appropriate first-line treatment for moderate Alzheimer’s disease?