单选题 21-year-old man presents to the Emergency Department with an acutely swollen, tender left knee. He has taken 180 mg of codeine over the past few hours. He has a history of sickle cell disease and has suffered a number of painful crises over the past few years. On examination, his BP is 145/72 mmHg, pulse is 98/min and regular, and he is in severe pain. The left knee is swollen and tender but not warm. He is apyrexial but tachypnoeic and O2 sats are measured at 91% on pulse oximeter. Investigations: Haemoglobin 7.0 g/dl (reticulocyte count 17%, many sickle cells seen) (13.5-17.5), White Cell Count 9.8 x 10^9/l (4-11), Platelets 178 x 10^9/l (150-400), Sodium 138 mmol/l (135-145), Potassium 4.7 mmol/l (3.5-5.0), Creatinine 130 μmol/l (50-120), pH 7.32 (7.35-7.45), Bicarbonate 22 mmol/l (24-30). Which of the following is the most appropriate next step?

单选题 Which investigation is most appropriate to demonstrate the likely cause of anaemia?

单选题 54-year-old man presents with a 2-month history of increasing lethargy. He also reports that he has been bruising more easily of late. On direct questioning he admits to passing dark urine, but denies any other urinary symptoms. A year ago he had finished a 6-month period of anticoagulant therapy for a spontaneous deep vein thrombosis. His full blood count demonstrates haemoglobin 6.5g/dl white blood- cell count 2.8× 10^9/l and platelets 27× 10^9/l What is the most appropriate management for his anaemia?

单选题 17-year-old, previously well, White girl presented to her general practitioner with tiredness. The following blood counts were obtained on laboratory testing: haemoglobin 6.8g/dl white blood cell count 10× 10^9/l platelets 365× 10^9/l and mean cell volume (MCV) of 67 fl. She had been on a paracetamol and codeine compound preparation for menorrhagia and dysmenorrhoea. She eats lots of vegetables, liver, eggs, steak and cereals. Which one of these causes is playing a significant role in the aetiology of her anaemia?

单选题 Which further investigation will be most helpful in terms of diagnosis?

单选题 Which organism is most likely to be causative?

单选题 25-year-old woman presents 2 days postpartum with sudden onset left-sided chest pain and shortness of breath. She is tachycardic and has a respiratory rate of 24 breaths per minute. She is started on intravenous unfractionated heparin. She is started on warfarin the day after when a ventilation/perfusion (V/Q) scan confirms a pulmonary embolus, but is slow to reach therapeutic anticoagulation and heparin is therefore continued. Eight days into the treatment she requires increasing doses of heparin to maintain a therapeutic activated partial thromboplastin time (APTT). On day ten she has a pale, pulseless and painful right foot. Which one of the following diagnostic laboratory results supports your clinical diagnosis?

单选题 Which one of the following is the most likely diagnosis?

单选题 17-year-old boy is visiting relatives in West Africa after schooling in England for his GCSEs. As part of his preparation to travel he has to be vaccinated against cholera and hepatitis A, and he has to take antimalarials such as primaquine. Two days after starting, he notices that his urine is dark and he experiences back pain. He is also jaundiced. Which one of these enzyme abnormalities is most likely to be responsible for his clinical symptoms?