Archives: Medical Student Years 1-3

MS-3371

A 50-year-old man presents to the emergency department with a 24-hour history of left knee pain and swelling. He has difficulty bearing weight on the left leg and reports no recent trauma, fevers, or chills. The patient has also been experiencing constipation, excessive urination, and fatigue for several months. He has a history of passing a kidney stone with hydration. He does not take prescription medications or use tobacco, alcohol, or illicit drugs.

During examination, the patient’s temperature is 37.2 ºC (98.9ºF) and blood pressure is 130/76 mmHg. The right knee is tender, erythematous, and swollen. Arthrocentesis reveals a white blood cell count of 30,000/mm3, with a predominance of neutrophils and numerous rhomboid-shaped crystals.

What substance is most likely the composition of the crystals?

MS-3372

A 31-year-old man arrives at the emergency department following a skateboard accident. He reports experiencing intense pain in his left lower leg. The patient has no significant medical history and is typically self-sufficient and healthy.

During the examination, the physician notes palpable tenderness and significant bruising on the lateral side of the left leg, just below the knee. The patient is unable to dorsiflex his left foot.

Which anatomical structure is most likely to be impacted?

MS-3373

A 43-year-old woman visits her GP with a complaint of pain in her left hand. She reports experiencing occasional pins and needles in her left thumb and index fingers on the palm of her hand for the past two months. The pain is more severe at night and sometimes prevents her from sleeping.

Which nerve is responsible for her symptoms?

MS-3374

You are the physician attending to a 32-year-old expectant mother who is experiencing discomfort in her thumb and index finger. She reports paraesthesia in the palmar region of her thumb and index finger, which worsens at night.

What nerve is likely to be impacted?

MS-3375

A 70-year-old man is recuperating from a fall that resulted in a fracture of his left fibular neck. He has observed that his left foot drags on the ground when he attempts to walk. Which nerve is the most probable to have been affected?

MS-3376

A 40-year-old male presents to the GP with fatigue and shortness of breath. He states that he is taking methotrexate for psoriasis. The GP takes some bloods, and finds the following results in his full blood count (FBC):

Hb 90 g/L
MCV 90 fL
Platelets 70 * 109/L
WBC 2.5 * 109/L
Neuts 1.5 * 109/L)
Lymphs 0.7 * 109/L
Mono 0.2 * 109/L
Eosin 0.1 * 109/L

The GP suspects this to be an adverse effect of methotrexate.

What adverse effect is indicated by these results?

MS-3377

A 48-year-old woman comes to the clinic complaining of chronic back pain. She has no known medical conditions and was recently hospitalized for a wrist fracture sustained while playing frisbee. The hospital discharged her with conservative management. Her blood test results are as follows:

Calcium 1.9 mmol/L (2.1-2.6)
Phosphate 0.8 mmol/L (0.8-1.4)
ALP 172 IU/L (44-147)
Parathyroid Hormone 65 pg/mL (15-65)

What is the probable diagnosis?

MS-3378

A 70-year-old man with a history of untreated hypertension and diabetes mellitus presents to the clinic with worsening bone and joint pain. Upon examination, diffuse muscular tenderness is noted but is otherwise unremarkable. The following blood test results are obtained:

Calcium 1.9 mmol/L (2.1-2.6)
Phosphate 2.0 mmol/L (0.8-1.4)
ALP 170 IU/L (44-147)
Parathyroid Hormone 70 pg/mL (15-65)

What is the most likely diagnosis?

MS-3379

A 79-year-old woman arrived at the hospital complaining of pain in her right hip and thigh after falling from her bed. According to her, she fell while attempting to get up and go to the bathroom during the night. During the physical examination, the physician observed that her right leg was externally rotated and shorter than her left leg. What is the most probable pathological alteration present in this woman?

MS-3380

A 70-year-old retired delivery man visits his family physician with a complaint of knee pain. He reports that the pain is present in both knees and worsens towards the end of the day. The pain usually subsides after resting and in the morning. He has been experiencing knee pain for the past few years and used to take paracetamol, which provided relief. However, the pain has recently intensified, limiting his ability to work. The patient occasionally experiences right hip pain, but it does not bother him much. The patient has a medical history of well-controlled diabetes mellitus, hypertension, and lower back pain. He has a body mass index of 32 kg per m2 and takes metformin, insulin, and candesartan regularly. On examination, there is no redness, swelling, or tenderness over the knees. The physician recommends an X-ray of both knees. What is the most probable X-ray finding?