Archives: Medical Student Finals

MSFinals-5715

A 35-year-old male patient presented to the Emergency department with sudden onset chest pain and shortness of breath that had been ongoing for six hours. The symptoms appeared out of nowhere while he was watching TV, and lying flat made the breathlessness worse. The patient denied any recent history of infection, cough, fever, leg pain, swelling, or travel.
Upon examination, the patient was apyrexial and showed no signs of cyanosis. Respiratory examination revealed reduced breath sounds and hyperresonance in the right lung.
What is the most likely diagnosis?

MSFinals-5708

A 50-year-old lady with known chronic obstructive pulmonary disease (COPD) is admitted to the Respiratory Ward with shortness of breath, cough and wheeze. On examination, she appears unwell and short of breath, and there is an audible wheeze. Her respiratory rate is 30 breaths per minute, pulse rate 92 bpm and oxygen saturations 90% on room air. She reports that she is able to leave the house but that she has to stop for breath after walking approximately 100 m. What grade on the MODIFIED MRC dyspnoea scale would this patient be recorded as having?

MSFinals-5707

A 55-year-old man with chronic kidney disease has recently received a renal transplant. After three months he starts to feel unwell with flu-like symptoms, fever, and pain over the transplant area.
What is the most likely type of reaction that has occurred in the patient?

MSFinals-5713

A 25-year-old woman comes to her GP complaining of breathlessness, dry cough and occasional wheezing.
What investigation finding would indicate a diagnosis of asthma?

MSFinals-5710

A 28-year-old man presents with right-sided pleuritic chest pain. He reports feeling a sudden ‘pop’ followed by the onset of pain and shortness of breath.
Upon examination, the patient appears to be struggling to breathe with a respiratory rate of 40 breaths per minute. Diminished breath sounds are heard on the right side of the chest during auscultation.
Diagnostic tests reveal a PaO2 of 8.2 kPa (normal range: 10.5-13.5 kPa) and a PaCO2 of 3.3 kPa (normal range: 4.6-6.0 kPa). A chest X-ray shows a 60% right-sided pneumothorax.
What is the most appropriate course of treatment for this patient?

MSFinals-5701

A 12-year-old male patient is referred to the renal physicians after several episodes of frank haematuria. He does not recall any abdominal or loin pain. He had an upper respiratory tract infection a few days ago. Urine dipstick shows blood, and blood tests are normal.
What is the most likely diagnosis?

MSFinals-5711

You are the Foundation Year 2 doctor on a general practice (GP) attachment when a 65-year-old man presents, complaining of malaise, cough and breathlessness. He says these symptoms have been present for 2 days, and he has brought up some yellow-coloured sputum on a few occasions. He reports no pain and no palpitations and is coping at home, although he has taken 2 days off work. He has no long-standing conditions but smokes five cigarettes a day and has done so for the last 15 years. He has no known allergies. On examination, he is alert and orientated, and has a respiratory rate of 22 breaths per minute, a blood pressure of 126/84 mmHg and a temperature of 38.1 °C. There is bronchial breathing and crepitations on auscultation, particularly on the right-hand side of the chest, and heart sounds are normal.
What would be the most appropriate management for this patient?

MSFinals-5714

A 45-year-old woman presents with sudden-onset shortness of breath and pleuritic chest pain. After workup, including blood tests, an electrocardiogram (ECG) and a chest X-ray, a diagnosis of pulmonary embolism (PE) is suspected.
In which situation might a ventilation/perfusion (V/Q) scan be preferred to a computerised tomography pulmonary angiogram (CTPA) to confirm a diagnosis of PE?

MSFinals-5705

A 7-year-old girl presents with haematuria, hearing loss, and poor eyesight caused by lens dislocation. After conducting additional tests, the diagnosis of Alport syndrome is made. What type of collagen is typically affected by a molecular defect in this disease?

MSFinals-5706

A 45-year-old writer presents to his routine follow up at the Nephrology Clinic complaining of numbness and tingling sensation of his right fingers. This worsens when he types for more than an hour and slightly improves when he stops typing. He suffers from diabetes mellitus and end-stage kidney disease and has been on regular haemodialysis via brachiocephalic fistula on his right antecubital fossa. On examination, his right radial artery is palpable and he has reduced sensation in all his right fingers, predominantly affecting the fingertips. The numbness does not worsen with tapping over the wrist nor with forced flexion of his wrists. His capillary refill time over his right fingers is prolonged to three seconds.
Which of the following is the most likely diagnosis?