Archives: Medical Student Finals

MSFinals-5858

A 72-year-old retired boiler maker presents to his General Practitioner with increasing shortness of breath and non-specific dull right-sided chest ache. He has a 35-pack-year history and has recently lost a little weight. On examination, there is evidence of a large right-sided pleural effusion.
Investigations:
Investigation
Result
Normal value
Sodium (Na+) 132 mmol/l 135–145 mmol/l
Potassium (K+) 4.5 mmol/l 3.5–5.0 mmol/l
Creatinine 120 μmol/l 50–120 µmol/l
Haemoglobin 115 g/l 135–175 g/l
Platelets 170 × 109/l 150–400 × 109/l
Chest X-ray: large right-sided pleural effusion.
Pleural tap: pleural effusion contains occasional red blood cells, white blood cells and abnormal-looking cells which look of a sarcomatous type.
Which of the following statements fits best with the underlying condition?

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?

MSFinals-5860

A 38-year-old man from Somalia presents at your general practice surgery as a temporary resident. He has noticed some lumps on the back of his neck recently. He reports having a productive cough for the last 3 months, but no haemoptysis. He has lost 3 kg in weight in the last month. He is a non-smoker and lives with six others in a flat. His chest X-ray shows several large calcified, cavitating lesions bilaterally.
What is the GOLD standard investigation for active disease, given the likely diagnosis?

MSFinals-5861

A 35-year-old woman had a productive cough due to upper respiratory tract infection two weeks ago. She experienced a burning sensation in her chest during coughing. About a week ago, she coughed up a teaspoonful of yellow sputum with flecks of blood. The next morning, she had a small amount of blood-tinged sputum but has not had any subsequent haemoptysis. Her cough is resolving, and she is starting to feel better. She has no history of respiratory problems and has never smoked cigarettes. On examination, there are no abnormalities found in her chest, heart, or abdomen. Her chest x-ray is normal.

What would be your recommendation at this point?

MSFinals-5827

An 80-year-old woman came to the Emergency Department complaining of severe dyspnoea. A chest X-ray showed an opaque right hemithorax. She had no history of occupational exposure to asbestos. Her husband worked in a shipyard 35 years ago, but he had no lung issues. She has never been a smoker. Upon thorax examination, there was reduced movement on the right side, with absent breath sounds and intercostal fullness.
What is the probable reason for the radiological finding?

MSFinals-5836

A 75-year-old man presents to the Emergency Department with complaints of difficulty breathing. Upon examination, you observe that his trachea is centralized and there is decreased chest expansion on the left side, accompanied by a dull percussion note and diminished breath sounds. What is the diagnosis?

MSFinals-5837

A 32-year-old female with a 10 year history of asthma presents with increasing dyspnoea after returning from a trip to Australia. She has not had a period in three months. On examination, she has a fever of 37.5°C, a pulse rate of 110/min, a blood pressure of 106/74 mmHg, and saturations of 93% on room air. Her respiratory rate is 24/min and auscultation of the chest reveals vesicular breath sounds. Peak flow is 500 L/min and her ECG shows no abnormalities except for a heart rate of 110 bpm. A chest x-ray is normal. What is the most likely diagnosis?

MSFinals-5838

A nurse in the Emergency Department presents an electrocardiogram (ECG) to you. The elderly patient is feeling breathless and has long-standing limited mobility. The ECG shows a sinus tachycardia with an S-wave in lead I, Q-wave in lead III and T-wave inversion in lead III.
What is the most likely diagnosis?

MSFinals-5839

A 62-year-old female patient complains of breathlessness and weight loss over the past three months. She is a smoker who consumes 10 cigarettes per day. During the examination, you observe clubbing of the fingers and a few crackles in the chest. What is the probable diagnosis?

MSFinals-5840

A 25-year-old lady with a history of asthma is brought to the Emergency Department with an acute asthma attack. She has previously been admitted to the intensive therapy unit (ITU) with the same problem. Treatment is commenced with high-flow oxygen and regular nebulisers.
Which of the following is a feature of life-threatening asthma?