Archives: Medical Student Finals

MSFinals-5831

A 68-year-old man with chronic obstructive pulmonary disease (COPD) visits his general practitioner (GP) complaining of increased wheezing, breathlessness, and a dry cough. He is able to speak in complete sentences.
During the examination, the following observations are made:
Temperature 37.2 °C
Respiratory rate 18 breaths per minute
Blood pressure 130/70 mmHg
Heart rate 90 bpm
Oxygen saturations 96% on room air
He has diffuse expiratory wheezing.
What is the most appropriate course of action for this patient?

MSFinals-5832

A 35-year-old man with acquired immune deficiency syndrome (AIDS) presents to the Emergency Department with fever, dyspnea, and overall feeling unwell. The attending physician suspects Pneumocystis jirovecii pneumonia. What is the most characteristic clinical feature of this condition?

MSFinals-5833

A 50-year-old woman has a small cell lung cancer. Her serum sodium level is 128 mmol/l on routine testing (136–145 mmol/l).
What is the single most likely cause for the biochemical abnormality?

MSFinals-5834

A 42-year-old man with advanced lung disease due to cystic fibrosis (CF) is being evaluated for a possible lung transplant. What respiratory pathogen commonly found in CF patients would make him ineligible for transplantation if present?

MSFinals-5835

A 67-year-old woman has had bowel surgery two days ago. She is currently on postoperative day one, and you are called to see her as she has developed sudden-onset shortness of breath. She denies any coughing but complains of chest discomfort. The surgical scar appears clean. Upon examination, the patient is afebrile; vital signs are stable other than rapid and irregular heartbeat and upon auscultation, the chest sounds are clear. The patient does not have any other significant past medical history, aside from her breast cancer for which she had a mastectomy five years ago. She has no family history of any heart disease.
What is the patient’s most likely diagnosis?

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?