Archives: Medical Student Finals

MSFinals-5775

A 49-year-old Caucasian woman presents with a severe acute attack of bronchial asthma. For 1 week, she has had fever, malaise, anorexia and weight loss. She has tingling and numbness in her feet and hands. On examination, palpable purpura is present and nodular lesions are present on the skin. Investigations revealed eosinophilia, elevated erythrocyte sedimentation rate (ESR), fibrinogen, and α-2-globulin, positive p-ANCA, and a chest X-ray reveals pulmonary infiltrates.
Which one of the following is the most likely diagnosis?

MSFinals-5777

A 49-year-old farmer presented with progressive dyspnoea. He had a dry cough and exercise intolerance. On examination, few crackles were found in the upper zones of both lungs. Surgical lung biopsy was done which was reported as:
Interstitial inflammation, chronic bronchiolitis, and two foci of non-necrotizing granuloma.
What is the most likely clinical diagnosis?

MSFinals-5784

A 55-year-old woman comes to her doctor complaining of wheezing, chest tightness, cough, and difficulty breathing for the past three days. She reports that this started shortly after being exposed to a significant amount of hydrogen sulfide at work. She has no prior history of respiratory issues and is a non-smoker. What would be the most suitable initial management approach to alleviate her symptoms?

MSFinals-5776

A 54-year-old smoker comes to the clinic with complaints of chest pain and cough. He reports experiencing more difficulty breathing and a sharp pain in his third and fourth ribs. Upon examination, a chest x-ray reveals an enlargement on the right side of his hilum. What is the most probable diagnosis?

MSFinals-5789

A 65-year-old man with chronic obstructive pulmonary disease (COPD) is brought to Accident and Emergency with difficulty breathing. On arrival, his saturations were 76% on air, pulse 118 bpm and blood pressure 112/72 mmHg. He was given nebulised bronchodilators and started on 6 litres of oxygen, which improved his saturations up to 96%. He is more comfortable now, but a bit confused.
What should be the next step in the management of this patient?

MSFinals-5790

A 28-year-old man with cystic fibrosis (CF) arrives at the Emergency Department (ED) with haemoptysis. During his stay in the ED, he experiences another episode of frank haemoptysis, which measures 180 ml.
A prompt computed tomography (CT) aortogram is conducted, revealing dilated and tortuous bronchial arteries.
What action could potentially harm the management of this patient?

MSFinals-5780

A 65 year-old man, who had recently undergone a full bone marrow transplantation for acute myeloid leukaemia (AML), presented with progressive dyspnoea over the past 2 weeks. There was an associated dry cough, but no fever. Examination revealed scattered wheezes and some expiratory high-pitched sounds. C-reactive protein (CRP) level was normal. Mantoux test was negative. Spirometry revealed the following report:
FEV1 51%
FVC 88%
FEV1/FVC 58%
What is the most likely diagnosis?

MSFinals-5787

A 28-year-old man with a history of cystic fibrosis is experiencing deteriorating respiratory symptoms and is subsequently diagnosed with aspergillus infection. What is a common pulmonary manifestation of Aspergillus infection?

MSFinals-5783

A 30-year-old woman comes to the General Practice Clinic complaining of feeling unwell for the past few days. She has been experiencing nasal discharge, sneezing, fatigue, and a cough. Her 3-year-old daughter recently recovered from very similar symptoms. During the examination, her pulse rate is 62 bpm, respiratory rate 18 breaths per minute, and temperature 37.2 °C. What is the probable causative organism for her symptoms?

MSFinals-5786

A 30-year-old man is brought to the Emergency Department after he suddenly collapsed while playing soccer, complaining of pleuritic chest pain and difficulty in breathing. Upon examination, the patient appears pale and short of breath. His pulse rate is 120 bpm and blood pressure is 105/60 mmHg. Palpation reveals a deviated trachea to the right, without breath sounds over the left lower zone on auscultation. Percussion of the left lung field is hyper-resonant.
What would be the most appropriate immediate management for this patient?