Archives: Medical Student Finals

MSFinals-6665

A 63-year-old man presents to his GP with a complaint of increasing blood in his urine over the past two weeks. He denies any pain or difficulty while urinating but reports feeling fatigued and possibly losing some weight over the last few months. He has a history of smoking with a 48 pack-year history. On examination, he has a heart rate of 70 bpm, blood pressure of 155/78 mmHg, oxygen saturation of 97% on air, and a temperature of 37.0ºC. There is tenderness in the left renal angle, and a palpable mass is felt on the left side. His abdomen is soft without anterior tenderness. Digital rectal exam reveals a non-enlarged and non-tender prostate. The urine dip results show leucocytes ++, blood +++, protein +, nitrites negative, glucose trace, and ketones negative. What is the most likely diagnosis?

MSFinals-6666

A 75-year-old man has been experiencing difficulty passing urine for the past 6 hours and is in significant discomfort. Upon catheterization, 1 litre of urine is drained and the patient experiences relief. During a PR examination, an enlarged, hard, nodular prostate is detected. The Urology Registrar advises admission and observation for 24 hours due to the risk of complications following an episode of acute urinary retention. What is the most crucial test to repeat within the next 12 hours to aid in identifying such a complication?

MSFinals-6667

A 28-year-old woman comes to the emergency department complaining of sudden lower abdominal pain that started 2 hours ago. She is sexually active and has not been using condoms lately. Although she has a long-term partner, she has not undergone any sexual health screening. During the examination, she experiences tenderness in the right iliac fossa, with a heart rate of 100 bpm, blood pressure of 120/75 mmHg, and a temperature of 37.8ºC. What is the initial investigation that should be conducted?

MSFinals-6668

A 54-year-old male visits the clinic with worries about red discoloration of his urine. He was diagnosed with a deep vein thrombosis (DVT) two months ago and has been taking warfarin. His most recent INR test, done two days ago, shows a result of 2.7. During the examination, no abnormalities were found, but his dipstick urine test shows +++ of blood and + protein. However, the MSU test shows no growth. What is the probable reason for this man’s condition?

MSFinals-6669

A twenty-five-year-old male with Crohn’s disease is admitted to the gastroenterology ward. Despite infliximab therapy, the patient’s symptoms persist, and he complains of abdominal pain and high output through his stoma. On examination, he appears pale and cachectic, with a heart rate of 74/minute, regular respiratory rate of 14/minute, oxygen saturations of 99%, temperature of 38.2 ºC, and blood pressure of 122/74 mmHg. The stoma bag is situated in the left iliac fossa, and the stoma site is pink and spouted without evidence of infarction or parastomal hernias. What type of stoma does this patient have?

MSFinals-6670

Which of the following interventions is most likely to decrease the occurrence of intra-abdominal adhesions?

MSFinals-6672

A 32-year-old male patient with a history of von Hippel-Lindau syndrome presents to the clinic with a painful swelling in his right scrotum. Upon examination, a 4 mm lump is palpable behind and distinct from the right testicle. There is no significant scrotal enlargement, redness, or discomfort during urination. The patient has normal vital signs and is afebrile, and tumour markers are within normal limits. What is the probable diagnosis?

MSFinals-6673

A 21-year-old man presents to his GP with a complaint of a lump in his scrotum that he noticed while showering. He reports feeling some discomfort in the area but denies any pain. He has been in a committed relationship with his girlfriend and had a clear sexual health screen two weeks ago.

Upon examination, the GP notes a soft mass on the anterior aspect of the right testis that cannot be distinguished from the testis itself. The lump is not tender to touch and transilluminates.

What is the most likely diagnosis for this patient?

MSFinals-6674

A 54-year-old woman without significant medical history visits her primary care physician complaining of a harsh, deep voice and painful swallowing that has persisted for four weeks. She also reports experiencing ear pain when swallowing. The patient has a history of smoking 20 packs of cigarettes per year and consuming 20 units of wine per week. Physical examination reveals no visible neck lumps or cervical lymphadenopathy, and direct visualization of the oropharynx is unremarkable. What is the most probable diagnosis?

MSFinals-6675

A 42-year-old male is set to undergo a laparoscopic cholecystectomy under general anaesthesia due to the presence of gallstones on abdominal ultrasound. All of his blood tests are normal and he is deemed suitable for surgery. However, he mentions to the medical team just before the anaesthesia is administered that he had a glass of orange juice without pulp prior to arriving at the theatre.

What is the best course of action for this patient?