Archives: Medical Student Finals

MSFinals-6653

A 67-year-old man is admitted to the colorectal ward after undergoing resection of a large adenocarcinoma in his descending colon. The surgery involved a left hemicolectomy and removal of two loops of small bowel and a partial cystectomy due to tumour invasion. He is currently five days post-operation and is managing well with adequate pain control. However, his catheter has drained 2000ml in the last 24 hours, and his abdominal surgical drain is still producing 200-300 ml of clear yellow fluid per day. There is a concern that his bladder wall repair may be leaking urine. What investigation should be ordered to provide the most definitive result in assessing the healing of the bladder suture line?

MSFinals-6654

A 9 month old boy is brought to the clinic by his mother who is worried about the location of his testes. She has only noticed them during bath time and not at any other time. What could be the possible diagnosis for this concern?

MSFinals-6655

Which one of the following is not typically observed in coning caused by elevated intracranial pressure?

MSFinals-6656

A 47-year-old woman has been experiencing constipation lately and noticed blood in her stool this morning. She decided to see her GP and reported having constipation for almost two months with only one instance of blood in her stool. Her husband, who accompanied her, mentioned that she has lost a considerable amount of weight recently. The woman confirmed this and stated that she has not been intentionally trying to lose weight. The GP is alarmed and orders an urgent investigation. What is the most appropriate investigation to be ordered at this stage?

MSFinals-6657

A 58-year-old man presents with acute urinary retention and a recent history of urinary tract infection. Bilateral hydronephrosis is observed on ultrasound. What is the most appropriate management plan?

MSFinals-6625

A fifty eight year old male presents with a four month history of an unresolved varicocoele in his left testis. Initially he was given symptomatic advice. He has now presented with macroscopic haematuria and flank pain. He describes having no energy despite being fit for his age. The testes are palpable. No discharge is elicited from the urethral meatus. His urine dipstick demonstrates blood +++ but is negative for leucocytes. You send him for a cystoscopy as you’re concerned he has presented with bladder cancer. The results are returned as normal. What is the most appropriate investigation to perform next in light of his normal cystoscopy?

MSFinals-6627

A 30-year-old man presents to the ED with sudden onset of pain and swelling in his left testicle. During the examination, the physician notes the absence of the cremasteric reflex. What additional finding would provide the strongest evidence for the most probable diagnosis?

MSFinals-6628

As a junior doctor on a surgical ward, you are tasked with admitting a 65-year-old woman with cholecystitis. She is scheduled for emergency surgery to remove her gallbladder the next day and is the first on the list. The patient has a history of type 2 diabetes mellitus and takes metformin 1g twice daily. Her recent HbA1c has come back elevated at 95 mmol/mol, but she has not yet seen her GP to discuss this. Her admission bloods show normal renal function. The ward nurse asks for guidance on how to manage the patient’s diabetes mellitus during the perioperative period. What is the most appropriate management plan?

MSFinals-6629

A 40-year-old man in a heterosexual relationship is seeking advice on contraception options after undergoing a vasectomy. What recommendations can be provided to him?