Archives: Medical Student Finals

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-5761

A 72-year-old woman is admitted with renal failure. She has a history of congestive heart failure and takes ramipril 10 mg daily and furosemide 80 mg daily.
Investigations:
Investigation Result Normal value
Haemoglobin 102 g/l 115–155 g/l
Platelets 180 × 109/l 150–400 × 109/l
White cell count (WCC) 6.1 × 109/l 4–11 × 109/l
Sodium (Na+) 143 mmol/l 135–145 mmol/l
Potassium (K+) 6.2 mmol/l 3.5–5.0 mmol/l
Creatinine 520 μmol/l 50–120 µmol/l
Chest X-ray: no significant pulmonary oedema
Peripheral fluid replacement is commenced and a right subclavian central line is inserted. She complains of pleuritic chest pain; saturations have decreased to 90% on oxygen via mask.
Which of the following is the most likely diagnosis?

MSFinals-5764

After reviewing a patient with chronic obstructive pulmonary disease (COPD) in clinic, the respiratory consultant discusses the anatomy of the lungs with a group of undergraduate students.
With regard to the lungs, which one of the following statements is accurate?

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-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?

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-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-5765

A 65-year-old woman presents to a spirometry clinic with a history of progressive dyspnea on exertion over the past six months, particularly when hurrying or walking uphill. What spirometry result would indicate a possible diagnosis of chronic obstructive pulmonary disease in this patient?

MSFinals-5772

A 67-year-old woman presents with right-sided pleural effusion. Thoracentesis is performed and the pleural fluid analysis reveals the following results:
Pleural fluid Pleural fluid analysis Serum Normal value
Protein 2.5 g/dl 7.3 g/dl 6-7.8 g/dl
Lactate dehydrogenase (LDH) 145 IU/l 350 IU/l 100-250 IU/l
What is the probable diagnosis for this patient?

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?