A 67-year-old female is admitted for an elective total hip replacement of the left hip. Upon admission, she is provided with thigh-length anti-embolism stockings to wear before surgery and until she regains mobility. The hospital follows a policy of administering low molecular weight heparin for postoperative thromboprophylaxis. As per NICE guidelines, at what point should this be initiated?
A 55-year-old woman presents to the clinic with a 9-month history of rectal bleeding and pain. Her physician decides to perform a proctoscopy. The results show an erythematous ulcerated plaque near the pectinate line, and biopsy results suggest squamous cell carcinoma. What is the most significant risk factor for this diagnosis?
A 55-year-old woman visits her GP complaining of a change in the shape of her left breast and a lump under her left armpit. She has previously undergone breast augmentation surgery which makes examination difficult, but there is a noticeable difference in the appearance of her breasts. She has no family history or other risk factors for breast cancer. The GP refers her to a specialist who performs an ultrasound of her breast and axilla. The ultrasound reveals a ‘snowstorm’ sign in the left breast and axillary lymph node. What is the most probable diagnosis?
A 54-year-old woman is admitted with sepsis due to ascending cholangitis. Her blood cultures reveal Escherichia coli that is susceptible to gentamicin. She has been receiving gentamicin treatment for 2 days, with normal levels. However, she continues to have a fever with chills, an increasing white blood cell count, and right upper quadrant tenderness. What is the probable cause of her symptoms?
An 80-year-old woman complains of colicky abdominal pain and a tender mass in her groin. Upon examination, a small firm mass is found below and lateral to the pubic tubercle. What is the most probable underlying diagnosis?
A 60-year-old man presents to his doctor with a 5-month history of frequent urination, urgency, and weak stream. Upon urinalysis, blood is detected. Following a multiparametric MRI, it is confirmed that the patient has prostate cancer. To treat his condition, he is prescribed the GnRH agonist goserelin and the anti-androgen cyproterone acetate. The patient is advised on the importance of taking cyproterone acetate. What is the purpose of cyproterone acetate in this treatment plan?
You are requested to examine a 65-year-old man at your clinic. He was diagnosed with an abdominal aortic aneurysm (AAA) 18 months ago after being invited to the national screening program. The aneurysm was initially measured at 4.5 cm in diameter. He has recently undergone his follow-up scan and was informed that his aneurysm has now increased to 5.8 cm in diameter. The patient is asymptomatic and feels healthy.
What would be the most suitable course of action for managing this patient?
A 65-year-old woman presents with severe colicky central abdominal pain, vomiting, and the passage of abnormal stool which had the appearance of redcurrant jelly.
On examination, temperature was 37.5°C, she has a pulse of 120 bpm with an irregular rate. Palpation of the abdomen revealed generalised tenderness and peritonitis.
Investigations reveal:
Haemoglobin 128 g/L (120-160)
White cell count 30 ×109/L (4-11)
Lactate 9 mmol/L (<2) pH 7.10 (7.36-7.44) She was taken to theatre for emergency surgery. What is the likely diagnosis?
A 27-year-old man presents to his GP with a painless lump in his right testicle that has been present for 4 months and has gradually increased in size. He has a medical history of type one diabetes mellitus, coeliac disease, and infertility. Additionally, he is a heavy smoker with a 20 pack-year history and consumes 30 units of alcohol per week. The GP suspects testicular cancer and refers the patient via the two-week-wait pathway. What is the most significant risk factor for this condition based on the patient’s history?
A 35-year-old male patient complains of a painless lump in his right testicle. What is the strongest association of testicular cancer?