Archives: Medical Student Finals

MSFinals-5693

A 56-year-old teacher presents to the Emergency Department with nausea and vomiting, with associated lethargy. She has mild asthma which is well controlled with a steroid inhaler but has no other medical history of note. She does not smoke but drinks up to 20 units of alcohol a week, mostly on the weekends. Observations are as follows:
Temperature is 37.2 oC, blood pressure is 110/70 mmHg, heart rate is 90 bpm and regular.
On examination, the patient appears to be clinically dehydrated, but there are no other abnormalities noted.
Blood tests reveal:
Investigation Result Normal Values
Haemoglobin (Hb) 140 g/l 135–175 g/l
White cell count (WCC) 7.8 × 109/l 4–11 × 109/l
Urea 8.5 mmol/l 2.5–6.5 mmol/l
Creatinine 190 µmol/l
(bloods carried out one year
previously showed a creatinine
of 80) 50–120 µmol/l
Potassium (K+) 4.7 mmol/l 3.5–5.0 mmol/l
Sodium (Na+) 133 mmol/l 135–145 mmol/l
Which of the following is most suggestive of acute kidney injury rather than chronic renal failure?

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?

MSFinals-5692

An 80-year-old man comes to his General Practitioner complaining of loin pain, haematuria and a palpable abdominal mass. He is diagnosed with renal clear cell carcinoma. Upon staging, it is discovered that the tumour has spread to the adrenal gland. What would be the primary management option for this patient?

MSFinals-5700

A 35-year-old teacher is tested for compatibility to donate a kidney to his older brother, who has end-stage renal failure. To his joy, he is found to be a suitable match. The patient is then thoroughly counselled regarding the operative procedure, short- and long-term risks, and the implications of living with one healthy kidney. He is particularly interested to learn how his body will adapt to having only one kidney.
What will be decreased in the donor after the kidney transplant?

MSFinals-5680

A middle-aged woman with a history of renal cell carcinoma complains of swelling in both legs extending from the groin area and dilated veins around the belly button. What is the underlying mechanism responsible for these symptoms?

MSFinals-5679

A 63-year-old man presented with fever, body ache and pedal oedema for three months. He was taking oral diclofenac frequently for the aches. He had no other drug history and had not travelled recently.
On examination, there was sternal tenderness. His blood report revealed:
Investigation Result Normal range
Haemoglobin 76 g/l 135–175 g/l
White cell count (WCC) 9 × 109/l 4–11 × 109/l
Erythrocyte sedimentation rate (ESR) 134 mm/hr 0–10mm in the 1st hour
Platelets 280 × 109/l 150–400 × 109/l
Urea 13 mmol/l 2.5–6.0 mmol/l
Calcium 2.8 mmol/l 2.2–2.6 mmol/l
What is the most likely cause of renal failure in this case?

MSFinals-5678

A 20-year-old man visits his GP clinic with a chief complaint of headaches. During the physical examination, no abnormalities are detected, but his blood pressure is found to be 178/90 mmHg. The doctor suspects a renal origin for the hypertension and wants to perform an initial screening test for renovascular causes. What is the most appropriate investigation for this purpose?

MSFinals-5675

A 76-year-old woman is admitted to the hospital feeling generally unwell. She has also developed a fever and diffuse erythematous rash over the last few days. Urinalysis is positive for blood and protein, and blood tests show raised eosinophils and creatinine. Her General Practitioner started her on a new medication two weeks ago, but she cannot remember the name or what it was for.
Which of the following drugs would be safe to continue at present, given the suspected diagnosis?

MSFinals-5676

A 50-year-old man with long-standing insulin-dependent diabetes mellitus was on dialysis, secondary to end-stage renal disease (ESRD). Three months ago, he received a kidney transplant, with his old kidney left in place. The transplanted kidney is attached to the central circulation, mimicking natural circulation. There are absolutely no signs of rejection, and the kidney is working perfectly. The patient is surprised to find out that he no longer has ‘thin blood’ because it has been years since he has not required medical management for his anaemia.
What is the main factor responsible for the normalization of his blood parameters and his recovery, following the kidney transplant?

MSFinals-5677

A 40-year-old piano teacher presented to the Emergency Department with an acute kidney injury (AKI) and was referred to the renal team for urgent haemodialysis. Which of the following is not a reason for immediate dialysis?