Archives: Medical Student Finals

MSFinals-5809

A 63-year-old man presents with complaints of dyspnoea, haemoptysis, and an unintentional 25 lb weight loss over the last 4 months. He reports a medical history significant for mild asthma controlled with an albuterol inhaler as needed. He takes no other medications and has no allergies. He has a 55 pack-year smoking history and has worked as a naval shipyard worker for 40 years. Examination reveals diffuse crackles in the posterior lung fields bilaterally and there is dullness to percussion one-third of the way up the right lung field. Ultrasound reveals free fluid in the pleural space.
Which one of the following set of test values is most consistent with this patient’s presentation?
(LDH: lactate dehydrogenase)
Option LDH plasma LDH pleural Protein plasma Protein pleural
A 180 100 7 3
B 270 150 8 3
C 180 150 7 4
D 270 110 8 3
E 180 100 7 2

MSFinals-5812

A 45-year-old woman with known asthma presents to the Emergency Department with severe breathlessness and wheeze.
Which of the following is the most concerning finding on examination and initial investigations?

MSFinals-5807

A morbidly obese 32-year-old man presents to his General Practitioner for review. His main reason for attendance is that his wife is concerned about his loud snoring and the fact that he stops breathing during the night for periods of up to 8–10 seconds, followed by coughing, snoring or waking. Recently he has become hypertensive and is also on treatment for impotence. His 24-hour urinary free cortisol level is normal.
Which diagnosis best fits this picture?

MSFinals-5810

A 56-year-old woman presents to the Emergency Department with a 2-week history of productive cough with green sputum and a one day history of palpitations. She also had some rigors and fever. On examination:
Result Normal
Respiratory rate (RR) 26 breaths/min 12–18 breaths/min
Sats 96% on air 94–98%
Blood pressure (BP) 92/48 mmHg <120/80 mmHg
Heart rate (HR) 130 bpm 60–100 beats/min
Some bronchial breathing at left lung base, heart sounds normal however with an irregularly irregular pulse. electrocardiogram (ECG) showed fast atrial fibrillation (AF). She was previously fit and well.
Which of the following is the most appropriate initial management?

MSFinals-5823

A 50-year-old woman is admitted to hospital with fever, dyspnoea and consolidation at the left lower base. She is commenced on antibiotics. A few days later, she deteriorates and a chest X-ray reveals a large pleural effusion, with consolidation on the left side.
What is the most important investigation to perform next?

MSFinals-5819

A 35-year-old woman with a history of asthma and eczema visits her General Practitioner and inquires about the reason for her continued wheezing hours after being exposed to pollen. She has a known allergy to tree pollen.
What is the most suitable explanation for this?

MSFinals-5818

A 14-year-old male is brought in with acute severe asthma. During examination, it is noted that his peripheral pulse volume decreases during inspiration. What is the most probable reason for this clinical finding?

MSFinals-5821

A 50-year-old man in the United Kingdom presents with fever and cough. He smells strongly of alcohol and has no fixed abode. His heart rate was 123 bpm, blood pressure 93/75 mmHg, oxygen saturations 92% and respiratory rate 45 breaths per minute. Further history from him reveals no recent travel history and no contact with anyone with a history of foreign travel.
Chest X-ray revealed consolidation of the right upper zone.
Which of the following drugs is the most prudent choice in his treatment?

MSFinals-5815

A 55-year-old smoker is referred by his General Practitioner (GP) for diagnostic spirometry after presenting with worsening respiratory symptoms suggestive of chronic obstructive pulmonary disease (COPD).
Regarding spirometry, which of the following statements is accurate?

MSFinals-5822

A 62-year-old man who is a smoker presents with gradual-onset shortness of breath, over the last month. Chest radiograph shows a right pleural effusion.
What would be the most appropriate next investigation?