16 year old girl present with a smooth, round and painless lump in the mid-line of the neck, of which she feels very self conscious. On examination, it is firm, transilluminates and is painless to touch. In addition, it moves up when the patient is asked to take a sip of water. This likely to be

45 year old female business executive presents with a swelling in the midline of the neck and features of hyperthyroidism secondary to Graves’ disease. Following a course of anti thyroid medication, a subtotal thyroid economy is performed. Raised titles of which immunoglobulin would be expected in this individual?

You are asked to assess a 25 year old patient who returned from theatre 2 hours ago following a thyroidectomy for a large, hyper plastic goitre and is now complaining of difficulty swallowing sips of water. On examination you note that she is shortness of breath with a respiratory rate of 30 breaths/min, using accessory muscles of respiration and only able to answer your questions in two or three words. In addition, there appears to be a fluctuating mass in the midline of the neck underlying the surgical clips. Immediate management of this patient would be:

28 year old secretary presents with a lump in the midline of the neck that has grown progressively larger over the past several months. On examination, there is a palpable lymph node in the left submandibular region. An aspirate is taken, confirming a malignant cancer of the thyroid glands. The origin of this is most likely to be

37 year old patient is diagnosed with medullary carcinoma of the thyroid gland. The concentration of which electrolyte could be reduced in this patient?

68 year old man presents with a 10 week history of a rapidly growing swelling in the midline of the neck. Prior to this problem developing he has been in excellent health. Over the past 10 weeks, he has begun to feel more worn out and is unable to complete his daily 3 mile walk without getting short of breath. His wife also reports that his voice has become increasingly hoarse in the last 2 weeks. The presentation is likely consistent with

50 year old fisherman presents with longstanding weight loss, anorexia and lethargy. Physical examination reveals a palpable swelling in the left supraclavicular fossa. A disseminated adenocarcinoma of the stomach is diagnosed following a gastroscope and CT scan of the thorax and abdomen. This patient has presented with

Which of the following structure does not form a border of the anterior triangle of the neck

45 year old woman is diagnosed with a submandibular calculus, having presented with a tender lump below the jaw on eating. Which structure is likely to be obstructed?

40 year old man presented with mouth long history of intermittent, left side pain and swelling in the anterior neck under the left jaw. His symptoms are associated with meal times and regress shortly after completing each meal. In recent days however, the pain appears to have become more intense and the swelling more firm. On examination a firm lump is palpable in the let submandibular region, bimanual palpation of which causes the patient to complain of a foul taste in his mouth. The most appropriate diagnostic investigation will be

54 year old builder attends your outpatient clinic with his wife, reporting an 8 month history of a lump on the left side of his face, in front of his ear. It is painless and does not trouble him. He has attended on the insistence of his wife, who worried that it may growing bigger. On examination, the swelling appears to lie anterior to the angle of the jaw on the let side. It is non tender and approximately 5cm in diameter with a clear edge. The skin is easily moved on top of it and the lump itself feels rubbery to touch. There is no cervical lymph nodes or facial droop evident on examination. An aspirate is taken which shows cells of many different type. A decision is made at a follow up appointment for excision. This likely to be?

6 year old boy presents with his mother to the general practice at which you are based, with a 3 week history of bilateral cheek swelling. The family is newly registered and medical records have not yet transferred to the practice. His mother informs you that the young boy has not received any of his childhood vaccinations, as she has been worried about their possible detrimental effects. The clinical suspicion is of mumps parotitis. Which class of infectious agent is responsible for mumps?

39 year old man of Italian origin presents complaining of an exquisitely tender area over his right buttock, which has been present for several weeks. Within the past few days, the area has begun to weep profusely and his temperature at home prior to admission was 38 degree Celsius. He reports having had this problem previously and was operated on during a previous admission. On examination you note that the man is extremely hairy and that there is an irregular, erythematous, warm and exquisitely tender shallow lump overlying the top of the right buttock. A small scar is seen over the lump and on palpation, it is fluctuant and discharges purulent fluid. A pilonidal abscess is suspected. Definitive management would consist of

56 year old priest presents with a lump at the back of his hand that has been getting larger over the past year. Although it does not trouble him, his parishioners are increasingly commenting on it after his Sunday service. On examination, there is a soft, non-tender, irregular lump on the dorsal of the hand 3x5cm in size. It is fluctuant on movement an transilluminates, but does not reduce when pressed down. The skin moves freely over it and no other such lumps are to be found on either arm, An aspirate produces a dark gelatinous material. This is most likely a

which one of the following muscle lies closest to the peritoneal cavity?

55 year old man with known atrial fibrillation presents to his general practitioner with a 3 month history of gynaecomestia. Which of his following medication is not associated with gynaecomastia?

Regarding hernias in females, the most common is

Which of the following structure form a part of both the inguinal and femoral canals?

35 year old professional weightlifter present with a red and swollen lump in the left groin. An inguinal hernia is suspected and at the time of operation, the lump is found to contain a small loop of necrotic bowel. This type of hernia is best describe as