CLINICAL CPS MSRA MOCK PAPER 9 (untimed) – answers immediately

A 55-year-old woman presents to the emergency department with a history of intermittent chest pain for the past month. The pain occurs during stress and physical activity and is relieved by rest. She has a history of diabetes and smokes 10 cigarettes a day. Her vital signs are stable. ECG shows no acute changes. Blood tests, including troponin levels, are normal.

Which medication should be prescribed first-line for the symptomatic relief of her angina?

A 59-year-old man diagnosed with 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 myocardial infarction?

A 50-year-old man with no significant medical history presents with chest pain lasting 20 minutes. The pain is described as tight and radiates to his left arm. He has no other symptoms. Vital signs are stable, and ECG shows T-wave inversion in leads V3 and V4. Troponin levels are normal.

What is the most likely diagnosis?

A 70-year-old woman with a history of non-ST-elevation myocardial infarction presents for a follow-up visit. The healthcare provider discusses potential long-term complications associated with the condition.

Which of the following is a significant long-term complication associated with non-ST-elevation myocardial infarction?

A 72-year-old woman with a history of chronic obstructive pulmonary disease (COPD) presents with sudden severe chest pain and shortness of breath. The pain radiates to her back and is described as tearing. Her blood pressure is 190/105 mmHg, and there is a difference in systolic blood pressure between her arms. An urgent CT angiography reveals a type B aortic dissection.

What is the most appropriate initial management for this patient?

A 70-year-old woman with a history of stable angina presents for a follow-up visit. The healthcare provider discusses potential long-term complications associated with the condition.

Which of the following is a significant long-term complication associated with stable angina?

A 55-year-old female presents to the respiratory clinic with a chronic productive cough and recurrent chest infections over the past few years. She has a history of childhood pneumonia and reports daily sputum production with occasional hemoptysis. On examination, coarse crackles are heard bilaterally in the lower lung fields. Chest X-ray shows tram-line shadows and dilated bronchi in the lower lobes.

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

A 68-year-old man presents with a chronic dry cough, progressive shortness of breath, and fatigue. He has a history of working in shipbuilding for over 30 years. Physical examination reveals digital clubbing and bibasilar crackles.

What are the most common symptoms of asbestosis?

A 30-year-old female presents to the respiratory clinic with chronic sinusitis, recurrent chest infections, and infertility. She reports a history of chronic cough with purulent sputum production and recurrent otitis media since childhood. On examination, there is digital clubbing, nasal polyps, and dextrocardia on auscultation. Chest X-ray confirms situs inversus.

Which of the following findings is a characteristic feature of Kartagener’s syndrome?

A 50-year-old woman with severe persistent asthma presents with daily symptoms of wheezing, shortness of breath, and frequent night-time awakenings. She is currently on a medium-dose ICS and LABA, but her symptoms remain poorly controlled.

What is the next step in managing her asthma?

A 24-year-old male presents to the GP with a 2-week history of persistent dry cough, low-grade fever, and general malaise. He mentions that several of his colleagues at work have had similar symptoms. On examination, his temperature is 37.8°C, respiratory rate is 18 breaths per minute, and oxygen saturation is 96% on room air. Chest auscultation reveals scattered crackles but no wheeze. A chest X-ray shows patchy infiltrates in the lower lobes.

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

A 8-year-old boy with mild persistent asthma presents with symptoms of wheezing and coughing, especially at night. He is currently using a short-acting beta-agonist (SABA) as needed but continues to have symptoms.

Which medication could be added to his regimen to help manage his asthma symptoms?

A 35-year-old woman presents to the clinic with fatigue, jaundice, and joint pain that has persisted for several weeks. She has no significant past medical history. On examination, she has jaundice and hepatomegaly. Her observations are: heart rate 80 bpm, respiratory rate 18 breaths per minute, blood pressure 120/75 mmHg, and temperature 37.0°3. Laboratory tests reveal elevated liver enzymes (AST and ALT), elevated total bilirubin, and positive anti-nuclear antibodies (ANA).

What is the most likely diagnosis?

A 60-year-old woman underwent laparoscopic Heller myotomy for achalasia six months ago. She now presents with heartburn and regurgitation.

Which of the following is a common complication of surgical management for achalasia?

A 34-year-old woman presents to the clinic with a 6-month history of chronic diarrhea, abdominal bloating, and unintentional weight loss. She also reports fatigue and occasional joint pain. On examination, she appears pale and has mild abdominal tenderness. Her observations are: heart rate 78 bpm, respiratory rate 16 breaths per minute, blood pressure 115/70 mmHg, and temperature 36.7°3. Laboratory tests reveal iron deficiency anemia and low serum ferritin levels.

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

A 75-year-old woman with a history of severe heart failure presents with diffuse abdominal pain and metabolic acidosis. Her mesenteric arteries are patent on imaging.

Which of the following is a common cause of non-occlusive mesenteric ischaemia?

A 40-year-old female with suspected ulcerative colitis presents with chronic diarrhoea, which is sometimes bloody, and lower abdominal pain. She also reports a recent increase in fatigue.

Which investigation is considered the gold standard for diagnosing ulcerative colitis?

A 45-year-old man presents with hematemesis after a night of heavy alcohol consumption and repeated vomiting. He has no significant past medical history.

Which of the following best describes the clinical presentation of a Mallory-Weiss tear?

A 65-year-old woman with a 20-year history of Type 2 diabetes mellitus presents with numbness and tingling in her feet for the past six months. She describes a “pins and needles” sensation that worsens at night. On examination, there is reduced sensation to light touch and vibration in both feet.

What is the most likely diagnosis?

A 55-year-old man with Graves’ disease has not responded to medical therapy and considers surgical options. The clinician discusses thyroidectomy.

Which of the following is the most appropriate indication for thyroidectomy in Graves’ disease?

A 35-year-old woman presents with fatigue, weight gain, and cold intolerance over the past six months. She also notes swelling in her neck. On examination, she has a diffusely enlarged, non-tender thyroid gland.

What is the most likely diagnosis?

A 60-year-old woman develops hypoparathyroidism following thyroid surgery. The clinician discusses the cause and management of her condition.

Which of the following is a common cause of hypoparathyroidism in post-surgical patients?

A 45-year-old woman presents with symptoms of fatigue, muscle spasms, and a tingling sensation around her mouth. She has a history of thyroidectomy for thyroid cancer.

What is the most likely cause of her hypoparathyroidism?

A 35-year-old woman presents with hypercalcemia, gastric ulcers, and visual disturbances. The clinician suspects MEN1.

Which of the following clinical features is most characteristic of MEN1?

A 58-year-old male with a 15-year history of type 2 diabetes presents for his routine check-up. He reports no new symptoms. His latest blood tests reveal an eGFR of 60 mL/min/1.73m², and his urine albumin-to-creatinine ratio (ACR) is 35 mg/mmol. He is on metformin and atorvastatin.

According to UK NICE guidelines, what is the most appropriate first-line treatment to reduce the progression of diabetic nephropathy in this patient?

A 65-year-old man with stage 4 CKD is being monitored regularly. The clinician discusses the key parameters to monitor in CKD patients.

Which of the following parameters is most important to monitor regularly in patients with chronic kidney disease (CKD)?

A 25-year-old male presents to the clinic with a painless lump in his left testicle that he noticed a month ago. He denies any history of trauma or infections. On examination, there is a firm, non-tender mass in the left testicle. Scrotal ultrasound reveals a solid hypoechoic mass. Serum tumor markers are obtained and show elevated alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (ß-hCG) levels.

What is the most likely diagnosis?

A 45-year-old woman with glomerulonephritis is being monitored for disease progression. The clinician discusses the important parameters to monitor.

Which of the following parameters is most important to monitor in patients with glomerulonephritis?

A 32-year-old female presents to her GP with dysuria, increased urinary frequency, and urgency for the past three days. She denies fever, flank pain, or vaginal discharge. Physical examination is unremarkable. A urine dipstick test shows positive nitrites and leukocyte esterase.

What is the most appropriate initial management for this patient?

A 30-year-old woman with recurrent kidney stones is suspected of having cystine stones. The clinician orders diagnostic tests to confirm the diagnosis.

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

A 65-year-old male presents to the emergency department with confusion, fever, and bleeding from his gums. He was recently diagnosed with sepsis secondary to a urinary tract infection. On examination, he has petechiae on his chest and abdomen, and there is oozing from venipuncture sites. Laboratory tests show a platelet count of 50,000/µL, elevated prothrombin time (PT), elevated activated partial thromboplastin time (aPTT), elevated D-dimer, and decreased fibrinogen levels.

What is the most likely diagnosis?

A 40-year-old woman with newly diagnosed iron deficiency anaemia presents with a haemoglobin level of 8 g/dL and significant fatigue. She is discussing treatment options with her clinician.

Which of the following is the recommended initial management for iron deficiency anaemia?

A 35-year-old woman presents to the emergency department with a 2-week history of easy bruising and petechiae. She denies any recent infections or new medications. On examination, she has multiple petechiae on her lower extremities and several large ecchymoses on her arms. Her complete blood count shows a platelet count of 15 x 10^9/L, with normal white cell and red cell indices.

What is the most appropriate initial treatment for this patient?

A 65-year-old man with known myelofibrosis presents with increasing abdominal pain and distension. Imaging reveals significant splenomegaly with splenic infarcts.

Which of the following is a known complication of myelofibrosis?

A 55-year-old man with a history of non-Hodgkin’s lymphoma presents to the emergency department with a one-day history of fever, chills, and abdominal pain. He received his last cycle of chemotherapy ten days ago. On examination, his temperature is 39.2°C, heart rate is 120 beats per minute, blood pressure is 90/50 mmHg, and respiratory rate is 22 breaths per minute. Blood tests reveal a white blood cell count of 0.8 x 10^9/L with an absolute neutrophil count of 0.2 x 10^9/12.

What is the most appropriate initial management for this patient?

A 30-year-old man with sickle cell disease presents with sudden onset of chest pain, fever, and difficulty breathing. He has a history of frequent pain crises.

Which of the following is a known complication of sickle cell disease?

A 45-year-old man presents to the clinic with a 1-week history of drooping of the right eyelid and a constricted right pupil. He denies any pain, trauma, or changes in vision. On examination, you notice right-sided ptosis, miosis, and anhidrosis of the face. The rest of the neurological examination is unremarkable.

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

A 55-year-old man presents with fever, severe headache, and neck stiffness. His condition deteriorates rapidly, and bacterial meningitis is suspected. The cerebrospinal fluid analysis confirms the diagnosis. The patient has a history of penicillin allergy, which causes a rash.

Which of the following antibiotics is most appropriate for initial empiric treatment of bacterial meningitis in this patient?

A 50-year-old woman presents with a three-month history of burning pain in her feet that is worse at night. She has type 2 diabetes mellitus diagnosed five years ago. On examination, she has decreased pinprick and light touch sensation in a stocking distribution.

Which of the following is the most appropriate first-line medication for her neuropathic pain?

A 7-year-old boy presents with progressive muscle weakness, particularly in the proximal muscles of his lower limbs. He has difficulty climbing stairs and often falls. A muscle biopsy shows significant muscle fiber degeneration. The clinician suspects a form of muscular dystrophy.

Which of the following best describes the pathophysiology underlying Duchenne and Becker muscular dystrophies?

A 60-year-old man reports experiencing severe, stabbing pain on the left side of his face for the past few months. The pain is triggered by shaving, brushing his teeth, and cold wind on his face. The episodes are brief but excruciating and occur several times a day. His past medical history includes hypertension, which is well controlled. On examination, there are no sensory or motor deficits.

Which of the following is the first-line treatment for his condition?

A 47-year-old man presents with a history of excruciating headaches that occur in clusters, typically several times a day over a period of weeks, followed by long periods without symptoms. The pain is always on the right side of his head, centered around his eye, and is associated with redness of the eye, tearing, and nasal congestion. He asks about the most important criteria for diagnosing his condition.

Which of the following is the most important criterion for diagnosing cluster headaches?

A 25-year-old medical student presents to the clinic with a 10-day history of fever, malaise, and abdominal discomfort. She recently returned from a research trip to a rural area in Africa. Blood cultures are pending, but you suspect typhoid fever.

Which diagnostic test is most appropriate to confirm typhoid fever?

A 40-year-old man presents with cellulitis on his lower leg. The infection is spreading rapidly, and the causative organism has not yet been identified.

Which of the following antibiotics is most appropriate for empirical therapy in this case?

A 28-year-old man is brought to the urgent care clinic after being bitten by a bat while hiking in a forest. The bite occurred about 12 hours ago, and he is concerned about the risk of rabies.

What is the most appropriate initial management for this patient?

A 55-year-old man presents with a red, swollen, and painful lower leg. The clinician considers other possible conditions that could present similarly.

Which of the following conditions is most important to differentiate from cellulitis?

A 34-year-old woman presents with painful genital ulcers and swollen lymph nodes in the groin. She had unprotected sex with a new partner three weeks ago. On examination, the ulcers are soft with undermined edges, and there is a purulent exudate. Inguinal lymph nodes are enlarged and tender.

What is the most appropriate diagnostic test for confirming chancroid?

A 10-year-old boy presents with a sore throat, fever, and difficulty breathing. On examination, a thick gray membrane is seen covering the tonsils and extending into the pharynx.

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

A 30-year-old male cyclist presents with wrist pain and deformity after a high-speed crash. On examination, there is significant swelling and tenderness over the distal radius. An X-ray shows a dorsal Barton’s fracture with subluxation of the radiocarpal joint.

What complication is most likely to occur if this fracture is not properly treated?

A 50-year-old woman with a diagnosis of fibromyalgia presents with persistent pain and fatigue despite trying various over-the-counter pain medications. She is looking for a comprehensive management plan to help improve her quality of life.

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

A 35-year-old woman with a history of scleroderma presents with worsening episodes of finger color changes in response to cold. She describes her fingers turning white, then blue, and finally red upon warming. She also notes that her fingers have become more painful during these episodes, and she has developed small ulcers at the tips of her fingers. On examination, there is evidence of skin tightening and telangiectasias.

What is the most appropriate next step in managing her condition?

A 75-year-old woman with a long-standing history of osteoarthritis in her hips and knees presents with increasing pain and decreased mobility. She now relies on a walker for assistance. She reports difficulty performing daily activities such as dressing and bathing. Examination reveals joint deformities and reduced muscle strength.

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

A 10-year-old boy presents to the emergency department with severe pain in his right leg, fever, and malaise. His parents report that he had a sore throat two weeks ago. On examination, his right leg is swollen, warm, and tender to touch. Laboratory findings include elevated white blood cell count, erythrocyte sedimentation rate (ESR), and CRP. MRI of the leg reveals a lytic lesion with surrounding bone edema.

Which pathogen is most likely responsible for this patient’s condition?

A 75-year-old man presents with severe left hip pain after tripping over a rug at home. He has a history of osteoporosis and has been on long-term corticosteroid therapy for chronic obstructive pulmonary disease (COPD). On examination, his left leg is shortened and externally rotated.

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

A 25-year-old man presents to the emergency department with severe sore throat, high fever, and difficulty swallowing. He is drooling and appears anxious, sitting forward to breathe. His voice is muffled, and he is unable to speak in full sentences. On examination, there is inspiratory stridor and signs of respiratory distress.

What is the most likely complication if this condition is not promptly treated?

A 60-year-old man with a history of tinnitus reports that the constant ringing in his ears is affecting his sleep and concentration. He has tried using white noise machines with minimal relief. He is seeking further management options to help cope with his symptoms.

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

A 50-year-old man presents with a six-month history of recurrent episodes of vertigo, each lasting several hours, associated with a roaring tinnitus and hearing loss in his left ear. He notes a feeling of fullness in the affected ear before the onset of symptoms. His medical history is otherwise unremarkable.

Which of the following tests is most likely to confirm the diagnosis of Meniere’s disease?

A 50-year-old man with a history of chronic post-nasal drip presents with persistent throat irritation and hoarseness. He has been experiencing these symptoms for several months, and over-the-counter treatments have not provided relief. Examination reveals erythema of the posterior pharynx and vocal cord irritation.

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

A 25-year-old male presents to the GP with a 3-day history of sore throat, fever, and difficulty swallowing. He also reports a headache and malaise but denies any cough or runny nose. On examination, his temperature is 38.5°C, and there is bilateral tonsillar enlargement with exudates. Cervical lymphadenopathy is present, and there are no signs of respiratory distress.

What is the most likely causative organism?

A 50-year-old woman with a history of asthma and aspirin sensitivity presents with worsening nasal obstruction and anosmia. She also has a history of atopic dermatitis. Nasal endoscopy reveals multiple bilateral nasal polyps.

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

A 60-year-old man presents with acute onset of eye pain, redness, and decreased vision in his right eye. He recently had cataract surgery. On examination, there is a central corneal ulcer with hypopyon and surrounding stromal infiltrate. The patient also reports photophobia and significant tearing.

Which of the following organisms is most commonly associated with postoperative corneal ulcers?

A 28-year-old woman presents with a sudden onset of vision loss in her right eye, associated with a relative afferent pupillary defect. She has been diagnosed with optic neuritis. Her visual acuity is significantly reduced.

Which is the most appropriate initial management for this patient?

A 68-year-old woman presents with excessive tearing, irritation, and redness of her right eye. She mentions that her eyelid seems to be sagging. Examination reveals eversion of the lower eyelid with exposure of the palpebral conjunctiva and punctate epithelial erosions on the cornea.

What is a potential complication of untreated ectropion?

A 35-year-old man presents to his GP with a 3-day history of progressive visual loss in his left eye, accompanied by dull ocular pain, especially with eye movements. He denies any trauma or systemic symptoms. Neurological examination reveals a relative afferent pupillary defect in the left eye. The GP suspects optic neuritis and plans to investigate further.

Which investigation is most appropriate to confirm the diagnosis of optic neuritis?

A 65-year-old woman presents with pain, redness, and vision loss in her right eye, three days after intravitreal injection for diabetic retinopathy. Examination reveals conjunctival injection, corneal edema, and an anterior chamber filled with white cells.

What is the most appropriate initial management for this condition?

A 40-year-old man with a history of herpes simplex keratitis presents with worsening eye pain, redness, and decreased vision in his right eye. He reports that the symptoms started two days ago and have progressively worsened. On examination, there is corneal haze and stromal edema noted on slit-lamp examination.

What is the most appropriate next step in management?

A 45-year-old man is referred to a neurologist due to progressive muscle weakness and a history of frequent falls. His mother and maternal grandfather had similar symptoms, which started in their 40s. Genetic testing confirms a mutation in the DMPK gene.

What is the most likely diagnosis?

A 15-year-old girl with a history of Turner’s syndrome 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 complication associated with Turner’s syndrome?

A newborn female is diagnosed with Tetralogy of Fallot during a routine check-up after presenting with cyanosis and a murmur. An echocardiogram confirms the diagnosis. The cardiologist discusses the timing of surgical intervention with the parents.

What is the typical age range for elective surgical repair of Tetralogy of Fallot?

A 2-year-old boy presents with leukocoria and poor vision in one eye. The healthcare provider suspects retinoblastoma and considers diagnostic tests to confirm the diagnosis and assess the extent of the disease.

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

A 4-year-old boy presents to the clinic with a noticeable bulge at his belly button that becomes larger when he coughs or strains. The hernia has been present since birth, and his parents are concerned about the need for surgery. The child is otherwise healthy and active with no signs of pain or discomfort.

What is the recommended management for an uncomplicated umbilical hernia in this age group?

A 2-year-old boy with a history of microcephaly 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 microcephaly?

A 35-year-old woman presents to her GP with a complaint of heavy menstrual bleeding for the past six months. She describes soaking through a pad every hour during the first three days of her period. She also reports passing large clots and feeling fatigued. Her menstrual cycles are regular, occurring every 28 days. She has no significant medical history and is not on any medications. Physical examination is unremarkable.

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

A 28-year-old woman with a BMI of 37 kg/m² has just delivered a baby boy at 39 weeks gestation. The baby has a birth weight of 4.5 kg and is being monitored in the neonatal intensive care unit (NICU).

Which of the following is a significant neonatal complication associated with maternal obesity?

A 30-year-old pregnant woman, G2P1, at 28 weeks of gestation presents to the emergency department with a swollen, painful left leg. She noticed the swelling over the past two days and reports that it has gradually worsened. On examination, her left calf is tender, erythematous, and markedly swollen compared to the right leg. She has no history of trauma or recent travel.

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

A 29-year-old woman at 41 weeks gestation is in active labour with continuous CTG monitoring. The CTG shows a sinusoidal pattern with absent variability and no accelerations.

What does this CTG pattern indicate?

A 41-year-old woman, G3P2, at 39 weeks of gestation presents for her routine antenatal appointment. She has a history of well-controlled gestational diabetes. Ultrasound shows an estimated fetal weight of 4.2 kg.

What is the most appropriate indication for induction of labour in this patient?

A 29-year-old woman in her second trimester (18 weeks) reports a recent history of rash, fever, and lymphadenopathy. She is concerned because she is unsure of her rubella vaccination status. She has not had any prenatal blood tests yet.

Which test would best confirm a recent rubella infection in this pregnant woman?

A 30-year-old woman with a history of cataplexy is curious about the underlying cause of her condition. She experiences sudden muscle weakness triggered by laughter and intense emotions.

Which neurotransmitter deficiency is primarily associated with narcolepsy with cataplexy?

A 45-year-old male presents to the psychiatric clinic with concerns raised by his family. They report that he has been insisting that his wife has been replaced by an identical imposter. The patient is otherwise functioning well and has no significant cognitive deficits. He has no history of mental illness and denies any hallucinations or other delusional beliefs.

Which of the following symptoms is most indicative of Capgras syndrome?

A 25-year-old woman describes episodes where she wakes up and is unable to move or speak for a few minutes. She often feels a sense of fear and sometimes sees shadowy figures in the room. These episodes occur several times a month and have been happening for the past year.

Which of the following is NOT a typical diagnostic feature of sleep paralysis?

A 28-year-old male presents to the psychiatric clinic with a history of unstable relationships, impulsivity, and intense fear of abandonment. He describes rapid mood swings, feelings of emptiness, and occasional self-harming behaviors. His interpersonal relationships are characterized by extremes of idealization and devaluation. He reports that his symptoms have persisted since late adolescence.

Which of the following symptoms is most indicative of borderline personality disorder (BPD)?

A 25-year-old man with bipolar disorder presents with a manic episode. He has been started on an antipsychotic medication in the hospital and is now being considered for long-term pharmacological management.

Which of the following medications is commonly used for long-term management of bipolar disorder to prevent manic episodes?

A 45-year-old male is referred to a psychiatrist after being discovered injecting himself with insulin to induce hypoglycemia. He has a history of multiple hospitalizations for unexplained hypoglycemic episodes. Despite normal blood work and no underlying medical condition, he continues to present with severe hypoglycemic symptoms. He admits to enjoying the attention and care he receives during hospital stays.

Which of the following is the most appropriate diagnosis?

A 5-year-old boy presents with symptoms suggestive of measles, including fever, rash, and Koplik spots. The healthcare provider considers diagnostic tests to confirm the diagnosis.

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

A 38-year-old male presents with skin lesions, diarrhea, and mental confusion. He has a history of chronic alcohol abuse and reports a diet low in protein and high in carbohydrates.

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

A 45-year-old male presents to his GP with multiple purplish-red nodules on his legs and feet. He has a history of HIV infection and is not currently on antiretroviral therapy. On examination, the nodules are non-tender and vary in size, with some coalescing into larger plaques. He also reports weight loss and night sweats over the past few months.

What is the most likely diagnosis in this patient?

A 25-year-old female presents to her dermatologist with several small, white, pearly bumps on her cheeks and forehead. She reports that the bumps have been present for several months and have not changed in size or appearance. They are not painful or itchy. On examination, the lesions are firm, 1-2 mm in diameter, and do not exhibit any signs of inflammation.

What is the most likely diagnosis in this patient?

A 50-year-old woman presents with intense itching and a yellowish hue to her skin. She denies any new medications, food allergies, or changes in her skincare routine. Physical examination reveals jaundice and excoriations but no primary rash. Blood tests show elevated bilirubin and alkaline phosphatase levels.

What is the most likely cause of her pruritus?

A 20-year-old woman presents with a widespread eruption of small, droplet-shaped, erythematous lesions on her trunk and proximal limbs. She recently had a sore throat and was treated for a streptococcal infection. The lesions are covered with fine scales.

What is the most likely diagnosis?

A 7-year-old girl with a history of atopic dermatitis presents with worsening pruritus and excoriated lesions on her flexural areas. Despite regular use of emollients, her condition is not well controlled.

What is the next most appropriate treatment option?

A 55-year-old man is diagnosed with malignant melanoma on his foot. The lesion is flat with irregular pigmentation and extends over the sole. The patient is of Afro-Caribbean descent, and this is the only pigmented lesion he has noticed.

Which subtype of malignant melanoma is most likely in this patient?

A 36-year-old man presents to the emergency department after ingesting cocaine. He is agitated, sweating profusely, and complains of chest pain. His blood pressure is 185/100 mmHg, and his ECG shows QRS widening and QT prolongation. Neurological examination reveals hyperreflexia and dilated pupils.

Which of the following is least likely to be associated with cocaine toxicity?