Archives: Medical Student Finals

MSFinals-5668

A 54-year-old woman presents with back and flank pain affecting both sides. She has been diagnosed some years ago with antiphospholipid antibody syndrome and has suffered from a previous deep vein thrombosis. On assessment, temperature is 36.7oC, heart rate is 76 bpm, blood pressure 128/80 mmHg and she is still passing urine.
Investigations:
Investigation Result Normal value
Sodium (Na+) 141 mmol/l 135–145 mmol/l
Potassium (K+) 6.3 mmol/l 3.5–5.0 mmol/l
Urea 17.3 mmol/l 2.5–6.5 mmol/l
Creatinine 325 μmol/l 50–120 µmol/l
Urine proteinuria +++
Which of the following diagnoses fits best with this clinical scenario?

MSFinals-5669

A 27-year-old woman presents to you with bilateral palpable flank masses and headaches. Her blood pressure is 170/100 mmHg and creatinine is 176.8 μmol/l. She has no past medical history of this, but her family history is significant for renal disease requiring transplant in her mother, brother and maternal grandmother.
On which chromosome would genetic analysis most likely find an abnormality?

MSFinals-5670

A 30-year-old man presents to the general practitioner (GP) with hypertension which fails to fall into the normal range after three successive measurements at the practice nurse. These were 155/92 mmHg, 158/96 mmHg and 154/94 mmHg. He has a past history of some urinary tract infections as a child. The GP arranges some routine blood tests.
Investigations:
Investigation Result Normal value
Haemoglobin 139 g/l 135–175 g/l
White cell count (WCC) 5.4 × 109/l 4–11 × 109/l
Platelets 201 × 109/l 150–400 × 109/l
Sodium (Na+) 139 mmol/l 135–145 mmol/l
Potassium (K+) 4.9 mmol/l 3.5–5.0 mmol/l
Creatinine 187 μmol/l 50–120 μmol/l
USS Left kidney 8.4 cm and appears scarred.
Right kidney 10.3 cm
Which of the following is the most likely diagnosis?

MSFinals-5640

A 40-year-old woman has been seen by her general practitioner (GP) with symptoms of moderate anxiety, including frequent panic attacks, feeling very tired all the time, poor appetite and a short temper. She is taking time off work, arguing with her family and friends and becoming increasingly isolated as a result of the symptoms. She has tried cognitive behavioural therapy but found no benefit. She would like to try medication, and the GP has agreed to start citalopram.
What advice should she be given before starting the medication?

MSFinals-5642

A 32-year-old woman with schizophrenia has been under the care of mental health services for a few years with a fluctuating pattern of illness. Her consultant, in collaboration with the patient’s Community Psychiatric Nurse (CPN), decides to initiate clozapine treatment. As a component of the prescription, she is registered into the Clozapine Monitoring Service scheme.
What is the primary rationale for her registration?

MSFinals-5643

A 32-year-old female is initiated on haloperidol for treatment-resistant schizophrenia. She visits her primary care physician with a complaint of neck pain and limited neck movement for the past 24 hours. Upon examination, she displays normal vital signs except for a mild tachycardia of 105 and neck stiffness with restricted range of motion. Her neck is involuntarily flexed towards the right. Her facial movements are normal. What is the probable diagnosis?

MSFinals-5644

A 45-year-old woman who is currently an informal inpatient at a mental health hospital is being evaluated for electroconvulsive therapy (ECT), a treatment she has never undergone before. What is an appropriate indication for ECT?

MSFinals-5645

A 32-year-old woman presents to her GP with a complaint of severe dyspareunia and loss of libido that has been ongoing for the past year. She has already been evaluated by a gynaecologist and discharged as all her tests were normal. She has undergone a pelvic ultrasound, laparoscopy, and blood tests for LH/FSH and TFTs, as well as low vaginal and endocervical swabs. She reports no symptoms of depression or anxiety and maintains a healthy lifestyle with regular exercise, good sleep, and a balanced diet. She denies any substance abuse. What is the most appropriate course of action?

MSFinals-5648

A 65-year-old-male presents to his GP with a chief complaint of forgetfulness over the past 3 months. He reports difficulty recalling minor details such as where he parked his car and the names of acquaintances. He is a retired accountant and reports feeling bored and unstimulated. He also reports difficulty falling asleep at night. His MMSE score is 27 out of 30. When asked to spell WORLD backwards, he hesitates before correctly spelling the word. His medical history includes hyperlipidemia and osteoarthritis. What is the most likely diagnosis?

MSFinals-5649

Samantha is a 38-year-old female who has come to the crisis team with suicidal thoughts. Upon further inquiry, Samantha also reveals experiencing low mood, lack of energy, early morning awakenings, and difficulty concentrating. She reports that these symptoms are persistent, but she has both good and bad days. Samantha has no prior psychiatric history. What medication would be the most suitable to initiate treatment for Samantha?