Archives: Medical Student Finals

MSFinals-5778

A 75-year-old woman presents to a respiratory outpatient clinic with a dry cough and shortness of breath that has been ongoing for 6 months. Despite being a non-smoker, her husband is a pigeon breeder. Upon examination, she has an SpO2 of 95% on room air and clubbing is present. Chest examination reveals symmetrical and bilateral reduced chest expansion with fine end-inspiratory crepitations. A chest radiograph shows increased interstitial markings in the lower zones of both lungs. High-resolution computed tomography (HRCT) confirms these findings and also shows bibasal honeycombing. There is no lymphadenopathy present on CT. What is the most likely diagnosis?

MSFinals-5779

A 44-year-old woman who is undergoing treatment for breast cancer has collapsed and has been brought to the Emergency Department. Upon regaining consciousness, she reports experiencing chest pain, shortness of breath, and reduced exercise capacity for the past 3 days. During auscultation, a loud pulmonary second heart sound is detected. An electrocardiogram (ECG) reveals right axis deviation and tall R-waves with T-wave inversion in V1-V3. The chest X-ray appears normal.
What is the most probable diagnosis?

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-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-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-5785

A 21-year-old man experiences sudden right-sided chest pain while exercising. The pain persists in the Emergency Department, but he is not short of breath. There is no past medical history of note. Observations are recorded:
temperature 36.6 °C
heart rate (HR) 90 bpm
blood pressure (BP) 115/80 mmHg
respiratory rate (RR) 18 breaths/minute
oxygen saturation (SaO2) 99%.
A chest X-ray reveals a 1.5 cm sliver of air in the pleural space of the right lung.
Which of the following is the most appropriate course of action?

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?

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-5788

A 63-year-old man presented with progressive dyspnoea and cough over two years. He was previously employed in a ceramic factory as chief supervisor.
What is the most probable radiological finding in this patient?

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?