Archives: Medical Student Finals

MSFinals-5855

A 29-year-old electrician was referred to the hospital by his doctor. He had visited his GP a week ago, complaining of malaise, headache, and myalgia for three days. Despite being prescribed amoxicillin/clavulanic acid, his symptoms persisted and he developed a dry cough and fever. At the time of referral, he was experiencing mild dyspnea, a global headache, myalgia, and arthralgia. On examination, he appeared unwell, had a fever of 39°C, and had a maculopapular rash on his upper body. Fine crackles were audible in the left mid-zone of his chest, and mild neck stiffness was noted.

The following investigations were conducted: Hb 84 g/L (130-180), WBC 8 ×109/L (4-11), Platelets 210 ×109/L (150-400), Reticulocytes 8% (0.5-2.4), Na 129 mmol/L (137-144), K 4.2 mmol/L (3.5-4.9), Urea 5.0 mmol/L (2.5-7.5), Creatinine 110 µmol/L (60-110), Bilirubin 89 µmol/L (1-22), Alk phos 130 U/L (45-105), AST 54 U/L (1-31), and GGT 48 U/L (<50). A chest x-ray revealed patchy consolidation in both mid-zones. What is the most likely cause of his abnormal blood count?

MSFinals-5848

An older woman presents to the Emergency Department with probable community acquired pneumonia (CAP). The consultant asks you to refer to the CURB-65 score to determine the next management plan.
Which of the following statements is part of the CURB-65 score?

MSFinals-5845

A 72-year-old man is diagnosed with right-sided pleural effusion. The aspirated sample reveals a protein level of 15g/l. What could be the potential reason for the pleural effusion?

MSFinals-5843

A 25-year-old male graduate student comes to the clinic complaining of shortness of breath during physical activity for the past two months. He denies any other symptoms and is a non-smoker. Upon examination, there are no abnormalities found, and his full blood count and chest x-ray are normal. What diagnostic test would be most useful in confirming the suspected diagnosis?

MSFinals-5854

A 58-year-old Afro-Caribbean man presents to you with increasing difficulty in breathing and shortness of breath. A chest examination reveals decreased expansion on the right side of the chest, along with decreased breath sounds and stony dullness to percussion. A chest X-ray reveals a pleural effusion which you proceed to tap for diagnostic serum biochemistry, cytology and culture. The cytology and culture results are still awaited, although the serum biochemistry returns back showing the following:
Pleural fluid protein 55 g/dl
Pleural fluid cholesterol 4.5 g/dl
Pleural fluid lactate dehydrogenase (LDH) : serum ratio 0.7
Which of the following might be considered as a diagnosis in this patient?

MSFinals-5857

A 14-year-old boy comes to your clinic complaining of wheezing for the past week. His mother mentions that he had a similar issue a couple of years ago but hasn’t had any problems since. He was treated with inhalers and recovered quickly at that time. The boy is an animal lover and has always had multiple pets, including dogs, cats, birds, and reptiles. He hasn’t acquired any new pets in the last two months. Upon examination, there are no clinical findings. What would be the best next step to take?

MSFinals-5852

A 35-year-old man has just returned from a trip to Kenya. He has been experiencing a productive cough with blood-stained sputum, fever, and general malaise for the past week. Upon testing his sputum, he is diagnosed with tuberculosis and is prescribed isoniazid, rifampicin, pyrazinamide, and ethambutol for the initial phase of treatment. What drugs will he take during the continuation phase, which will last for four months after the initial two-month phase?

MSFinals-5844

A 10-year-old boy comes to the GP clinic with his father for an asthma check-up. He is currently on Clenil® Modulite® (beclomethasone) 100 μg twice daily as a preventer inhaler, but still needs to use his salbutamol inhaler 2-3 times a day. During the examination, he is able to complete sentences, not using any accessory muscles of respiration, his oxygen saturation is 99%, his chest is clear, and PEFR is 85% of his predicted value. What is the recommended next step in managing this patient according to the latest BTS guidelines?

MSFinals-5853

A 70-year-old woman comes to the clinic with left upper-lobe cavitating consolidation and sputum samples confirm the presence of Mycobacterium tuberculosis, which is fully sensitive. There is no prior history of TB treatment. What is the most suitable antibiotic regimen?

MSFinals-5859

A 10-year-old boy visits his General Practitioner complaining of feeling unwell for the past two days. He reports having a sore throat, general malaise, and nasal congestion, but no cough or fever. During the examination, his pulse rate is 70 bpm, respiratory rate 18 breaths per minute, and temperature 37.3 °C. The doctor notes tender, swollen anterior cervical lymph nodes. What investigation should the doctor consider requesting?