Archives: Medical Student Finals

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-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-5712

A 52-year-old man with a history of chronic obstructive pulmonary disease (COPD) presents to the Emergency Department with an acute exacerbation. He is experiencing severe shortness of breath and his oxygen saturation levels are at 74% on room air. The medical team initiates treatment with 15 litres of high-flow oxygen and later transitions him to controlled oxygen supplementation via a 28% venturi mask. What is the optimal target range for his oxygen saturation levels?

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-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-5694

A 69-year-old man, with CCF is admitted with SOB and a productive cough. Clinical findings, and a chest X-ray suggest a diagnosis of both pulmonary oedema and pneumonia. He is put on high flow oxygen and treated with furosemide, GTN spray and morphine, and started on antibiotics.
His breathlessness improves, and a repeat chest X-ray shows decreased pulmonary oedema. An ABG shows the following:
pH: 7.01 (normal 7.35–7.45)
p(CO2): 8 kPa (normal 4.5–6.0 kPa)
p(O2): 11 kPa (normal 10–14 kPa)
HCO3–: 18 mmol (normal 24–30 mmol/l)
base excess: 1.2 mmol/l (normal −2 to +2.0 mmol/l)
sodium: 142 mmol/l (normal 135–145 mmol/l)
potassium: 5.9 mmol/l (normal 3.5–5.0 mmol/l)
glucose: 7.5 mmol/l (normal 5–5.5 mmol/l)
lactate: 3.1 mmol/l (normal 2.2–5 mmol/l).
Based on the patient, which of the following does he have that is an indication for acute dialysis?

MSFinals-5695

A 60-year-old woman presents for review of her chronic kidney disease.
Her investigation results show:
Investigation Result Normal range
Calcium 1.70 mmol/l 2.20–2.60 mmol/l
Potassium 6 mmol/l 3.5–5.0 mmol/l
Phosphate 2.5 mmol/l 0.70–1.40 mmol/l
Urea 80 mmol/l 2.5–6.5 mmol/l
Creatinine 400 μmol/l 50–120 μmol/l
What is the mechanism for the low calcium?

MSFinals-5697

A 30-year-old woman presents to the Renal Clinic for review. She has suffered from two recent urinary tract infections, and asymptomatic haematuria has been noted on urine dipstick testing on two separate occasions. She reports costovertebral angle tenderness on a few occasions in the past year. On examination, there is no residual tenderness today. Her blood pressure is 145/92 mmHg.
Investigations:
Investigation Result Normal value
Haemoglobin 119 g/l 115–155 g/l
White cell count (WCC) 6.2 × 109/l 4–11 × 109/l
Platelets 256 × 109/l 150–400 × 109/l
Sodium (Na+) 145 mmol/l 135–145 mmol/l
Potassium (K+) 4.8 mmol/l 3.5–5.0 mmol/l
Creatinine 100 μmol/l 50–120 µmol/l
Abdominal plain X-ray Multiple pre-calyceal calcifications
affecting both kidneys, with a
‘bunch of grapes’ appearance
Which of the following diagnoses fits best with this clinical picture?

MSFinals-5699

A 67-year-old retired bus driver presents to the Emergency Department with end-stage renal disease due to diabetic nephropathy. What is the most probable histological finding on kidney biopsy for this patient?