The Docsaab's Diary

New logo!

5 days ago | [YT] | 1

The Docsaab's Diary

79. A 62-year-old man presents with a painless lump in his right groin that has been present for 6 months. The lump is soft, non-tender, and reduces when he lies down. It becomes more prominent on coughing or straining. He has no systemic symptoms.

On examination, the lump appears above and medial to the pubic tubercle, and you can feel the cough impulse with your fingertip placed over the superficial inguinal ring.

What is the most likely diagnosis?

1 week ago | [YT] | 0

The Docsaab's Diary

78. A 26-year-old woman presents with a 2-day history of dysuria, urinary frequency, and urgency. She is otherwise well and afebrile, with no flank pain, haematuria, or vaginal discharge. This is her first episode of urinary symptoms. Urine dipstick shows:
Nitrites: Positive
Leukocyte esterase: Positive
Blood: Negative
What is the most appropriate next step in her management?

2 weeks ago | [YT] | 1

The Docsaab's Diary

77. A 13-year-old boy is brought to your clinic by his mother with a 3-month history of pain just below his right kneecap. He is otherwise well and plays football 4 times a week. The pain worsens during running and jumping but improves with rest. On examination, there is tenderness and a prominent, slightly swollen bony lump over the tibial tuberosity. Knee movement is normal.

What is the most appropriate next step in management?

1 month ago | [YT] | 1

The Docsaab's Diary

76. A 48-year-old man is referred for evaluation of fatigue and increased thirst over the past 3 months. He has no significant past medical history.

His blood test results are as follows:

Test Result Reference range

Fasting plasma glucose 7.2 mmol/L <5.6 mmol/L
Random plasma glucose 11.0 mmol/L <7.8 mmol/L
HbA1c 48 mmol/mol <42 mmol/mol


He is asymptomatic apart from mild fatigue.

What is the most appropriate next step?

1 month ago | [YT] | 1

The Docsaab's Diary

75. A 58-year-old man presents with a 6-month history of difficulty achieving and maintaining erections. He has type 2 diabetes, hypertension, and is on ramipril and metformin. He reports a normal libido but is distressed by his symptoms. He denies depression, relationship problems, or morning erections. Cardiovascular and genital examinations are normal.

What is the most appropriate next step in management?

1 month ago | [YT] | 1

The Docsaab's Diary

74. A 48-year-old woman presents to your surgery after noticing a painless lump in her right breast for the past 3 weeks. She has no nipple discharge, skin changes, or family history of breast cancer. On examination, you palpate a 2 cm firm, irregular, non-tender mass in the upper outer quadrant of the right breast. There is no axillary lymphadenopathy.

What is the most appropriate next step in management?

1 month ago | [YT] | 1

The Docsaab's Diary

73. A 29-year-old woman presents with frequent episodes of intense anxiety over the past 4 months. She describes palpitations, trembling, sweating, and a fear that she is “going to die” during these episodes, which peak within 10 minutes and resolve spontaneously after about 20 minutes. In between episodes, she worries constantly about having another attack and avoids public places. Physical examination and baseline blood tests are normal.

What is the most likely diagnosis?

1 month ago | [YT] | 1

The Docsaab's Diary

72. A 72-year-old man with a history of poorly controlled hypertension is brought to the emergency department by his wife. He developed a sudden, severe headache followed by left-sided weakness and slurred speech 1 hour ago. On examination:

GCS: 13 (E4 V4 M5)

BP: 210/110 mmHg

Pupils: Equal and reactive

No neck stiffness

Left hemiparesis present

A non-contrast CT brain performed urgently shows a right basal ganglia intracerebral haemorrhage.

Which of the following is the most appropriate immediate management step?

1 month ago | [YT] | 0

The Docsaab's Diary

71. A 67-year-old man presents with intermittent calf pain when walking about 200 m, which resolves with rest. He has a 30 pack-year smoking history, hypertension, and type 2 diabetes. On examination:

Lower limb pulses: Reduced dorsalis pedis bilaterally

Capillary refill: Prolonged

ABPI: 0.65 (right), 0.7 (left)

Which of the following is the most appropriate initial management?

2 months ago | [YT] | 0