Breast etc Flashcards
1
Q
Breast abscess MRSA?
A
– MRSA – trimethoprim 160-800mg BD PO
2
Q
stellate mass on XR
A
Radical scar
Biopsy ± excision
3
Q
clear / blood-stained discharge
A
Intraductal papilloma
Microdochectomy (removal or lactiferous duct) is the tx
4
Q
Risk of BRCA?
A
o 1st degree relative premenopausal relative with breast cancer
5
Q
o Paget’s disease of the nipple
A
An eczematoid change of the nipple associated with an underlying breast malignancy
Present in 1-2% of patients with breast cancer (in half of these patients, it is associated with an underlying mass lesion 90% = invasive carcinoma; 10% = carcinoma in situ)
6
Q
Breast lymph drainage
A
75% to lateral axillary nodes
7
Q
o Radiotherapy recommendations?
A
Recommended after WLE
Recommended after mastectomy if T3 or T4 or ≥4 +ve LNs
8
Q
Coroner Referral
A
o Unexpected or sudden deaths
o Not seen within 14 days before death
o Death occurs within 24 hours of hospital admission
o Accidents, injuries and suicide
o Industrial injury or disease (e.g. asbestosis)
o Deaths occurring as a result of ill treatment, starvation or neglect
o Death occurred during an operation or before recovery from the effect of an anaesthetic
o Poisoning, including taking illicit drugs
o Stillbirths - if there is doubt as to whether the child was born alive
o Prisoner or people in police custody
o Service disability pensioners
9
Q
Tetanus?
A
o Had full course of tetanus vaccines, with the last dose > 10yo:
Tetanus prone wound reinforcing dose of vaccine
High-risk wounds reinforcing dose of vaccine + tetanus IVIG
10
Q
1st line for major bowel resection pain relief?
A
Spinal/epidural
11
Q
o Painless ulcer (perianal) + painful lymphadenopathy
A
LGV
12
Q
o Painful ulcer + painful lymphadenopathy
A
= chancroid
Haemophilus ducreyi; S/S: painful sharply defined and ragged ulcer with painful lymphadenopathy
13
Q
Typhoid s/s
A
Cough (dry) Anorexia (WL +++)
Malaise, myalgia GI symptoms (by 2nd week; diarrhoea or constipation)
Sphygmothermic dissociation / Faget’s (fever, bradycardia)
Picture: splenomegaly, bradycardia, trunk rose-spots
14
Q
Ix and mx?
A
Investigations:
Blood culture [diagnostic]
Other – FBC, LFTs, stool culture
Management:
1st line = IV ceftriaxone OR IV cefotaxime
2nd line = PO azithromycin
15
Q
dengue
A
Primary infection:
* Headache (retro-orbital)
* Fine erythematous sunburn-like rash (50%)
* High fever and myalgia
Other = hepatomegaly, abdominal distension
Severe = low WCC, low platelets, haemorrhage
16
Q
Ix & mx dengue?
A
supportive treatment
17
Q
Neurological lesions HIV?
A
o Toxoplasmosis multiple lesions, ring enhancement, thallium SPECT -ve
o CNS lymphoma single lesion, homogenous enhancement, thallium SPECT +ve
18
Q
Chlamydia tx?
A
Azithromycin stat♀️ or doxycycline
19
Q
Gonorrhoea tx?
A
Azithromycin stat + ceftriaxone IM stat♀️
20
Q
Chronic sickle cell?
A
hydroxyurea/hydroxycarbamide
21
Q
Myasthenia Gravis Ix?
A
Antibodies and EMG
22
Q
Thymomas are associated with what?
A
Thymomas
23
Q
Tuberous sclerosis
A
AD; ash-leaf spots (fluoresce under UV), Shagreen patches, butterfly angiofibromas, subungual fibromata, cafe-au-lait spots
24
Q
Eye. nerve palsies
A
CN IV palsy - eye up, vertical diplopia (trauma)
CN VI palsy - eye medial, horizontal diplopia (raised ICP)
25
Crohn's tx?
Inducing remission - #1 steroids PO/IV, #2 infliximab IV
Maintaining remission - azathioprine PO
Isolated peri-anal disease - metronidazole PO
Refractory or fistulating disease - infliximab PO
26
SBP treatment?
Tx: cefotaxime IV
Prophylaxis: ciprofloxacin PO
27
LTOT in COPD?
LTOT if PaO2 <7.3 or PaO2 <8 with pulmonary hypertension, polycythaemia, nocturnal hypoxaemia or peripheral oedema
28
Causes of HAP?
Pseudomonas - #1 HAP
29
Lights criteria
Lights criteria - assess cause if effusion if pleural protein 25-35g/L
Exudative if one of:
Pleural protein/serum protein >0.5 (relative)
Pleural LDH /serum LDH >0.6 (relative)
Pleural LDH >⅔ UL normal (absolute)
30
Diffuse scleroderma
Diffuse cutaneous - RF, anti-scl-70/anti-topoisomerase
Scleroderma (trunk, proximal limbs), hypertension, lung fibrosis, renal involvement
31
Diagnosing Sjorgren's syndrome?
Schirmer’s test (<5mm wetting in 5m), bloods (RF, anti-Ro, anti-La)
32
Polymyositis antibody?
anti-Mi-2
33
tx of dermatomyositis?
Prednisolone
34
Treatment for Raynaud's
Tx: nifedipine
35
Causes of osteomyelitis?
Staph aureus (unless sickle cell disease then salmonella)
36
tx of osteomyelitis?
Tx: flucloxacillin
37
tx of septic arthritis
gram pos - vancomycin; gram neg - ceftriaxone; MSSA/MRSA or strep - flucloxacillin
38
Criteria in septic arthritis?
Kocher criteria - fever >38.5, non-weight bearing, high ESR, high WCC
39
MARFAN’S SYNDROME
AD defect in fibrillin I
40
EHLERS-DANLOS SYNDROME
AD defect in type III collagen
41
Behcet’s syndrome
oral ulcers + genital ulcers + anterior uveitis
42
Polyarteritis nodosa
renal artery aneurysms
43
Takayasu’s arteritis
Inflammation of the aorta and major branches causing limb claudication, weak/absent pulses, uneven BP
44
Goodpasture’s syndrome
anti-GBM against type IV collagen, pulmonary haemorrhage → rapidly progressive crescentic glomerulonephritis
45
Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)
pANCA, asthma + eosinophilia
46
Microscopic polyangiitis
cANCA, pANCA, rapidly progressive crescentic glomerulonephritis
47
Granulomatosis with polyangiitis (Wegener’s granulomatosis)
cANCA, epistaxis + haemoptysis + rapidly progressive crescentic glomerulonephritis
Saddle shaped nose
48
Prophylactic antibiotics in COPD?
Azithromycin
49
Mammary duct ectasia
Perimenopausal
Brown-green discharge
Nipple inversion
Areolar lump
49
Chemo in breast cancer
If node +ve offer chemo
50
Axillary node clearance
If lymphadenopathy → axillary node clearance
51
Surgery and radiotherapy indications in breast cancer?
Wide local excision + radiotherapy (solitary, peripheral, small in large breast, DCIS <4cm)
Mastectomy + radiotherapy if T3/T4 (multifocal, central, large in small breast, DCIS >4cm)
52
Post-partum thyroiditis tx?
Hyper phase - propranolol
Hypo phase - levothyroxine
53
Thyroid cancer monitoring?
thyroglobulin (Tg) levels ± calcitonin if medullary
54
Papillary thryoid cancer spread?
Lymphatic
55
Follicular thryoid cancer spread?
haemategenous
56
Branchial cyst
Lateral in anterior triangle by hyoid, develops in teens/young adults
Remnant of second branchial cleft, regular smooth mass, contains cholesterol-rich fluid
57
Hypernatraemia tx?
Correct water deficit
58
Hyponatraemia tx?
Hypovolaemic - 0.9% NaCl
Euvolaemic - fluid restrict
Hypervolaemic - fluid restrict ± loop diuretic
59
Cushing's disease Ix?
1. Low-dose overnight dexamethasone suppression test (low normal, high Cushing’s syndrome)
2. Plasma ACTH (undetectable ACTH-indep, detectable ACTH-dep)
3. High-dose overnight dexamethasone suppression test (low pituitary adenoma, high ectopic production)
60
Ix for prolactinoma?
1. Serum prolactin
2. MRI
61
Urate stones on scans?
Radioluscent
62
Markers in testicular cancer
Seminoma - LDH high
Teratoma - AFP high
hCG,
63
Prostate cancer normally originates where?
Adenocarcinoma of peripheral zone
64
Acute graft failure
<6mo, T-cell mediated, usually due to mismatched HLA or CMV, may be reversible with steroids and immunosuppressants
65
Alport's syndrome
X-linked (defect in type IV collagen gene)
Sx: nephritic syndrome, bilateral sensorineural deafness, lenticonus, retinitis pigmentosa
66
NEPHRITIC SYNDROME
Hypertension + oliguria + haematuria
67
A 19 year old man has pain in the ulnar aspect of his right hand since he threw a punch with his right fist. Which structure is most likely to have been injured?
Fifth metacarpal
68
A 44 year old man is admitted for a day-case knee arthroscopy. He is first on the list and is scheduled for 09.00. He drank a cup of black coffee at 06.00. He has a history of oesophagitis and has suffered severe nausea and vomiting after general anaesthesia for a hernia repair. He is recovering from a cold but still has a hoarse voice.
His temperature is 37.2°C and BP 160/95 mmHg. His throat is inflamed. Which clinical feature is most likely to indicate postponing the operation?
Laryngitis
69
Ix for epidymo-orchitis?
USS to rule out other pathology
FBC, urine dipstick, GUM, Syphilis
Bloodborne virus screen
Mumps serology (if clinically indicated)
Blood cultures (if pyrexial)
70
Abx for epidydmo-orchitis?
STI related epididymo-orchitis:
Ceftriaxone, 500mg-1g, IM single dose AND
Doxycycline, 100mg BD, 10-14 days
Urinary pathogen-related epididymo-orchitis:
Ofloxacin, 200mg BD, 14 days OR
Levofloxacin, 500mg, OD, 10 days
71
Prostatitis cause?
E. coli
72
Imaging prostatitis?
MRI prostate: allows assessment of the prostate and to screen for the development of an abscess.
73
abx for prostatitis?
First line: Oral ciprofloxacin 500 mg twice daily or ofloxacin 200 mg twice daily
Second line: Oral levofloxacin 500 mg once daily, or co-trimoxazole 960 mg twice daily
74
BPH tx?
Alpha-blockers
5-alpha reductase inhibitors (e.g. Finasteride):
75
Haematuria - 2ww for what?
Cystoscopy is the diagnostic modality of choice.
76
Chronic prostatitis?
Features are those of > 3 months of urogenital pain, often associated with LUTS and sexual dysfunction.
77
Hydrocele?
USS
78
Epidydmal cyst?
An epididymal cyst is a harmless fluid-filled growth on a man's testicle (testis). They are quite common and don't usually require treatment. Many men feel them and are concerned that they have testicular cancer, but a doctor can usually tell the difference by examination and/or using an ultrasound scan.
Transilluminates
79
Ix testicular cancer?
Testicular USS is the diagnostic modality of choice.
80
Tumour markers testicular cancer?
LDH = bith seminoma and non-seminoma
AFP =
BCG =
81
Treatment for testicular cancer?
Orchidectomy must be performed via an inguinal approach.
82
Cremasteric reflex in testicular torsion?
Absent! (stroking thigh)
83
Prehn's sign?
states that elevation of the affected testicle relives the pain of epididymitis but not of testicular torsion.
84
COPD vaccines?
Patients should have the pneumococcal and annual flu vaccine.
85
Asthma ix:
Fractional exhaled nitric oxide (FeNO)
Spirometry with bronchodilator reversibility
Where there is diagnostic uncertainty after initial investigations, the next step is testing the peak flow variability.
Where there is still uncertainty, the next step is a direct bronchial challenge test with histamine or methacholine.
86
Erythema multiforme
herpes simplex; target lesions; clobetasol 0.05% cream or prednisolone
87
Pyoderma gangrenosum
Crohn's
88
Dermatophytosis/tinea - trichophyton rubrum; (athlete's foot)
- terbinafine 1% cream
89
Marjolin’s ulcer
SCC that develops in a scar
90
Pityriasis rosea
HHV-7, after viral infection; herald patch → rash
91
Port-wine stain
present at birth, not raised, permanent
92
Strawberry haemangioma
develops after birth, raised, not permanent
93
Mumps ix?
PCR testing on a saliva swab. The blood or saliva can also be tested for antibodies to the mumps virus.
94
Gram negative diplococci
Neisseria gonorrhoeae.
95
Gonorrhoea ix?
Nucleic acid amplification tests (NAATs) are the principle diagnostic tests for gonorrhoea.
First-pass urine: equivalent sensitivity to urethral swabs, preferred method in men.
Vulv-vaginal swabs: first choice in women
96
Alternative to metronidazole BV?
Clindamycin
97
BV
Amsel criteria
pH > 4.5 is suggestive of BV.
Clue cells
Vaginal pH > 4.5
Typical discharge: thin, off-white/grey, homogenous and smoothly coats vaginal wall
Positive whiff-amine test: development of fishy odour with addition of 10% potassium hydroxide to vaginal discharge
Clue cells (on microscopy): vaginal epithelial cells studded with adherent coccobacilli
98
Painful ulcers?
HSV
99
Treatment of Chancroid?
Single dose treatment with azithromycin should be avoided in patients who are co-infected with HIV. In these cases ciprofloxacin or erythromycin is usually preferred.
Single dose options:
Azithromycin 1 g orally as a single dose, OR
Ceftriaxone 500 mg intramuscularly as a single dose, OR
Multi-dose options:
Ciprofloxacin 500 mg orally twice daily for three days, OR
Erythromycin 500 mg orally four times a day for seven days
100
Serovars
C. trachomatis
Trachoma (A-C): contagious bacterial eye infection
Urogenital (D-K): classic chlamydia infection
LGV (L1-L3): genital ulcer disease
101
Chlamydia tx?
Doxycycline 100 mg twice daily for 7 days (first-line)
Azithromycin 1 g once only, followed by 500 mg orally for the next two days (second-line)
Erythromycin 500 mg twice daily for 10-14 days (if above two treatment contraindicated)
102
Granuloma inguinale?
Klebsiella granulomatis.
Patients usually develop a painless papule(s) or nodule(s) that has a ‘beefy red’ appearance due to the high vascularity. Lesions typically occur on the genital region (~90%) or inguinal region (~10%).
can cause chronic scarring with lymphoedema.
103
Granuloma inguinale tx?
a minimum three week course of azithromycin.
Gentamicin can be added in patients slow to respond. Relapse can occur up to 18 months following treatment.
104
LGV?
Doxycycline is considered the first line treatment for LGV.
First line:
Doxycycline 100 mg twice daily for 21 days, OR
Tetracycline 2 g once daily for 21 days
Second line:
Erythromycin 500 mg four times a day for 21 days, OR
Azithromycin 1 g weekly for 3 weeks
105
Pediculosis pubis
Pubic lice
Infection by Phthirus pubis (crab louse).
Pediculosis pubis is characterised by pruritus (itching).
106
s/s of pediculosis pubis
Pruritus
Visible lice
Small bluish macules (0.5-1.0 cm): due to prolonged infestation and injection of natural anticoagulant from lice saliva during feeding.
Lymphadenopathy (rarely)
107
Tx of pediculosis pubis?
Topical permethrin is the treatment of choice for pediculosis pubis.
Pyrethrins 0.33% with piperonyl butoxide 4%.
Rarely oral treatment is needed. The main option is Ivermectin given at 200 mcg/kg as two single doses seven days apart.
108
Trichomoniasis
Protozoan
Strawberry cervix
Trichomoniasis classically causes a malodorous, frothy green-yellow discharge.
Vulval inflammation
109
Syphillis serological tests?
Syphilis is diagnosed using serological tests.
110
Secondary syphillis
presentation with the classic maculopapular skin ras
111
Syphillis treatment?
The treatment of syphilis is with parenteral penicillin.
Early syphilis:
Benzathine penicillin 2.4 Million units, IM single dose.
Late syphilis (cardiovascular or gummatous):
Benzathine penicillin 2.4 million units, IM weekly for three weeks (3 doses)
Prednisolone 40-60 mg for three days if cardiovascular (see Jarisch-Herxheimer reaction)
Neurosyphilis:
Procaine penicillin 1.8-2.4 million units IM once daily plus probenecid 500 mg QDS for 14 days, OR
benzylpenicillin 10.8-14.4 g daily, given as 1.8-2.4 g IV every 4 hours for 14 days.
Prednisolone 40-60 mg for three days (see Jarisch-Herxheimer reaction)
Syphilis in pregnancy:
Benzathine penicillin 2.4 million units IM single dose in the first and second trimesters. Further dose in the third trimester followed by a second dose after one week.
112
Vulval candida?
Clotrimazole
113
Treatment for recurrent thrush?
Induction course: oral anti-fungal (e.g. fluconazole) or 10-14 day course of anti-fungal pessary
Maintenance course: oral anti-fungal or anti-fungal pessary given as needed if symptoms recur. Alternatively, give a six month maintenance course then review.
114
Case control study
In a case-control study, a sample of individuals are identified and divided into those with a particular characteristic and those without it.
115
Cross-sectional study
In a cross-sectional study, a sample of individuals is identified and information is collected often with participant completed questionnaires.
This type of study is commonly used for the provision of official statistics. In the United Kingdom, studies include the Health Survey for England and the Adult Dental Health Survey.
116
A 43 year old man is rescued from a house fire. There are no signs of burns to the face or neck, but he has soot deposits in his nose and mouth.
His temperature is 37.5°C, pulse rate 120 bpm, BP 135/86 mmHg, respiratory rate 20 breaths per minute and oxygen saturation 97% breathing air. He has widespread wheeze.
Which is the most appropriate management?
Non-rebreather mask and 100% oxygen
117
A 42 year old man reports that his left testicle has been swollen for the past 3 weeks. He is otherwise well. There is a firm, round swelling at the upper pole of the left testis.
Which is the most likely diagnosis?
Epididymal cyst
118
A 64 year old man with a two year history of intermittent claudication presents with worsening lumbar back pain, not related to movement. He has type 2 diabetes mellitus.
Examination of his abdomen and spine is normal, but he has an absent right popliteal pulse and absent pulses in his left foot.
Which is the most appropriate initial investigation?
Abdo USS
119
An 80 year old woman has recurrent abdominal pain approximately 20 minutes after she has a meal. She has noticed weight loss of 14 kg over the past six months.
She is thin and has tarstained fingers. Her temperature is 36.5°C and pulse rate 85 bpm. She has an abdominal bruit.
Which is the most likely diagnosis?
Mesenteric angina
120
A 69 year old woman has constant dribbling of urine and has had to wear pads continuously for the last 12 month. She had radiotherapy for carcinoma of the cervix when she was 48 years old.
Her temperature is normal. Her bladder is not palpable or tender and neurological examination is normal.
Which is the most likely cause of her symptoms?
Vesicovaginal fistula
121
A 62 year old woman has blurred vision and extreme pain in her right eye of sudden onset. She is nauseated, has a headache and is seeing haloes around bright lights. The ocular pressure is reduced with drugs. The ophthalmologist explains to the patient that medical management alone is likely to be insufficient to reverse the problem.
Which I the most appropriate surgical treatment?
Laser peripheral iridectomy
122
A 40 year old man has an extensive rash that started 2 days ago and is worsening. He is shivering and feeling generally unwell. He has no past medical history, but has recently been treated for a chest infection.
His skin is now red over most of the body, with some large blisters and some areas of erosion. There is extensive ulceration in the mouth, and the conjunctivae are injected.
Which is the most likely diagnosis?
TEN
123
A 20 year old man has 14 weeks of cervical lymphadenopathy. He has a cough and has been sweating at night, and has lost 10% of his body weight. A lymph node biopsy reveals a proliferation of lymphoid cells, with scattered, large binucleate cells and prominent nucleoli.
Which is the most likely diagnosis?
Hodgkin lymphoma
124
A 70 year old man has 24 hours of cramping abdominal pain, bloating and complete constipation. He has had 2 months of intermittent diarrhoea.
His abdomen is distended, with lower abdominal tenderness. He has an appendicectomy scar. Abdominal X-ray shows large bowel obstruction.
Which is the most likely underlying cause for his presentation?
Adhesions – more likely in small bowel obstruction
Colorectal cancer – more likely in large bowel obstruction
125
A 29 year old man presents after a fall on to his outstretched left arm.
The left shoulder is deformed and there is sensory loss over the deltoid muscle. The radial pulse is palpable and the patient is able to extend his wrist.
What nerve is most likely to have been damaged?
Axillary
126
Calcaneal fracture imaging to plan for surgery?
CT
127
A 35 year old man has pain in his left foot for three months; it is worse after playing football but improves when he keeps his foot still. Recently, the pain has become more persistent. He is unable to recall any specific injury that may have brough on the pain. He plays sport several times a week. He is otherwise fit and well. There is tenderness over the mid-foot.
What is the most likely diagnosis?
Metatarsal stress fracture
128
A 60 year old man has been unable to hear with his left ear for 6 months.
Examination of both ear canals is normal. Tuning fork tests suggest sensorineural hearing loss in the left ear.
Which is the most likely diagnosis?
Acoustic neuroma
129
Gram positive bacteria
Gram-positive cocci include Staphylococcus (catalase-positive), which grows clusters, and Streptococcus (catalase-negative), which grows in chains
130
High LDH haem?
Autoimmune haemolytic anaemia
Direct antiglobulin test
131
A 47 year old man has nausea and epigastric pain. He undergoes endoscopy and biopsy, and he is found to have a carcinoma of the lesser curve of the gastric body. His case is discussed at the multidisciplinary team meeting.
Which lymph node group is most likely to be the site of metastasis?
Coeliac
132
A 24 year old man has had a high speed motorcycle crash. A cervical spine fracture is suspected and a series of cervical spine X-rays is requested.
Which X-ray view is most likely to reveal a vertebral body crush facture?
Lateral
133
A 75 year old man develops difficulty speaking and swallowing two days after a right carotid endarterectomy.
On examination of his cranial nerves, his tongue deviates to the right on protrusion.
Which is the most likely cause of this problem?
Damage to the hypoglossal nerve
134
A 75 year old man has increased urinary frequency, nocturia (four times per night), poor urine flow and reduced urinary volumes over the past six months. Urinalysis shows glucose trace, blood and protein negative.
Investigations: electrolytes: normal
serum creatinine 387 µmol/L (60-120)
random blood glucose 5.6 mmol/L
Which is the most likely cause of his renal impairment?
Obstructive uropathy - BPH
135
A 67 year old woman has weakness in her left arm and shoulder. She has recently undergone a left mastectomy and lymph node dissection for breast carcinoma.
She has reduced abduction in her left shoulder and winging of the scapula.
Which nerve is most likely to have been damaged?
Long thoracic nerve
(Innervates serratus anterior)
136
A 65 year old woman attend for routine breast screening. She has no symptoms of breast disease, no relevant family history and is not on any medication. She has a normal breast examination. The mammogram shows and area of focal microcalcification.
Which is the most common pathological cause?
Ductal carcinoma in situ (DCIS)
137
Hemiarthroplasty?
Replacement of the head and neck of the femur
138
A 66 year old man has had left sided abdominal discomfort for the pat 1 month.
He has widespread purpura and a palpable spleen measuring 17 cm from the left costal margin. There is no hepatomegaly or lymphadenopathy.
Investigations:
Haemoglobin 85 g/L (130-175)
White cell count 0.5 x 109/L (3.0-10.0)
Platelet count 38 x 109/L (150-400)
INR 1.0 (1.0)
Activated partial thromboplastin time 31 s (22-41)
Which is the most likely diagnosis?
Myelofibrosis
139
Monitoring for FAP
Sigmoidoscopy or colonoscopy every 1 to 2 years starting at age 10 to 12 for people with FAP. Individuals with AFAP should undergo colonoscopy beginning at age 18 to 20.
Yearly colonoscopy once polyps are found until a colectomy is planned
140
A 70 year old man has bright red rectal bleeding. Rigid sigmoidoscopy reveals a smooth and pedunculated polyp, 1 cm in diameter and 3 cm from the anal margin.
Which type of tumour is this polyp most likely to be?
Adenoma
141
Membranous nephropathy
Nephrotic syndrome
142
A 40 year old woman attends the ear, nose and throat clinic with a series of episodes of vertigo over the past 3 years. Each episode is preceded by a feeling of fullness in her left ear. The attacks last several hours and leave her with left sided tinnitus and deafness. She sometimes vomits during the attacks. An audiogram shows a left sided sensorineural hearing loss.
Which is the most likely diagnosis?
Ménière's disease
143
A 22 year old woman has a painless swelling in the left side of her neck. She first discovered the lump several months ago and noticed that it became slightly more prominent after a recent cold.
She looks well. Her temperature is 37.2°C. There is a 3 cm x 4 cm oval, non-tender, fluctuant mass along the lower third of the anteromedial border of the sternocleidomastoid muscle.
Which is the most likely diagnosis?
Brachial cyst
144
A 28 year old man has a headache, intermittent fever, sore throat and diarrhoea.
He has a temperature of 37.7°C. His facies are red and there are two small aphthous ulcers on his left buccal mucosa. He also has a maculopapular erythematous rash on his upper trunk, red hands and folliculitis on his chest. His liver and spleen are just palpable and he has mild neck stiffness.
Investigations:
haemoglobin 135 g/L (130-175)
white cell count 3.3 x 109/L (3.0-10.0)
platelets 84 x 109/L (150-400)
Which next investigation is most likely to lead to a diagnosis?
HIV serology??
145
Palpable loin mass?
Polycystic kidney disease
146
Measles transmission?
Respiratory droplet
147
