Archives: Medical Student Finals

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-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-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-5766

A 28-year-old woman presents to her Occupational Health Service. She works in the sterile supplies group at her local hospital. Over the past few months, she has noticed increasing shortness of breath with cough and wheeze during the course of a working week, but improves when she takes a week off on holiday. On examination at the general practitioner’s surgery, after a few weeks off, her chest is clear.
Peak flow diary:
Monday p.m 460 l/min (85% predicted)
Tuesday p.m 440 l/min
Wednesday p.m 400 l/min
Thursday p.m 370 l/min
Friday p.m 350 l/min
Saturday a.m 420 l/min
Which of the following is the most appropriate treatment choice?

MSFinals-5762

A 67-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. He also had a dry cough, but no fever. During examination, scattered wheeze and some expiratory high-pitched sounds were observed. The C-reactive protein (CRP) level was normal, and the Mantoux test was negative. Spirometry results showed a Forced expiratory volume in 1 second (FEV1) of 51%, Forced vital capacity (FVC) of 88%, and FEV1/FVC of 58%. What is the most likely diagnosis?

MSFinals-5769

A 47-year-old woman has been hospitalized with haemoptysis and epistaxis. On her chest X-ray, there are several rounded lesions with alveolar shadowing. Her serum test shows a positive result for cytoplasmic anti-neutrophil cytoplasmic antibody (c-ANCA). What is the probable diagnosis?

MSFinals-5760

A 63-year-old male smoker arrived in the Emergency Department by ambulance. He had become increasingly breathless at home, and despite receiving high-flow oxygen in the ambulance he is no better. He has a flapping tremor of his hands, a bounding pulse and palmar erythema.
What is the most likely cause of his symptoms?

MSFinals-5771

A 40-year-old baker presents to his General Practitioner with rhinitis, breathlessness and wheeze. He reports his symptoms have acutely worsened since he returned from a 2-week holiday in Spain. He has been experiencing these symptoms on and off for the past year. He has a fifteen-pack-year smoking history.
What is the most likely diagnosis?

MSFinals-5770

A 65-year-old woman presents to the Emergency Department with a productive cough, difficulty breathing, and chills lasting for 4 days. Upon examination, bronchial breathing is heard at the left lower lung base. Inflammatory markers are elevated, and a chest X-ray shows consolidation in the left lower zone. What is the most frequently encountered pathogen linked to community-acquired pneumonia?

MSFinals-5767

A 45-year-old man presents to his GP with persistent wheezing and difficulty breathing. Despite being prescribed a salbutamol inhaler, his symptoms continue and he is forced to take time off work. His GP increases his treatment by adding oral prednisolone, which initially helps but his symptoms return upon returning to work. However, during a two-week vacation, his wheezing significantly improves. Upon returning to work, he suffers an acute asthma attack and is taken to the hospital by ambulance. Which diagnostic test is most likely to confirm the diagnosis?