Archives: Medical Student Finals

MSFinals-4550

A 10-year-old boy visits his family doctor complaining of a limp that has been bothering him for the past 48 hours. He mentions having a runny nose and cough for a few days, but he feels better today. He reports pain in his left hip.
During the examination, the boy seems to be in good spirits and can bear weight with an antalgic gait.
His blood pressure is 110/70 mmHg, and his heart rate is 90 beats per minute. His respiratory rate is 16 breaths per minute, and his temperature is 38.5ºC.
What is the most appropriate course of action based on this information?

MSFinals-4551

A three-day-old baby who has not passed meconium is presenting with a distended abdomen and vomiting green bile. A congenital condition affecting the rectum is suspected. What test is considered diagnostic in this case?

MSFinals-4552

A 14-year-old boy presents to the emergency department with his parents complaining of sudden onset right-sided groin pain and inability to bear weight after a fall. On examination, he has a decreased range of motion and an antalgic gait. His heart rate is 96 bpm, blood pressure is 118/76 mmHg, BMI is 31 kg/m², and he is afebrile. What is the most probable finding on examination for this diagnosis?

MSFinals-4553

A 7-year-old child is brought to the GP practice for an urgent appointment by their parent. They have a 7 day history of fever and dry cough but in the last 24hrs their parent has become increasingly concerned about their breathing. They also report the child is refusing food and has had very few wet nappies.
The child’s observations are oxygen saturation 93% on air, respiratory rate 58 breaths/min, heart rate 160 bpm, blood pressure 85/45 mmHg and temperature 38.1ºC.
On examination, the child’s breathing appears rapid with marked intercostal recession and use of accessory muscles. They are also making a grunting noise.
Which of these findings would indicate immediate referral to hospital by ambulance?

MSFinals-4554

The ward doctor is requested to assess a 24-hour-old neonate, born at 35 weeks gestation to a healthy mother via an uncomplicated vaginal delivery. Upon examination, the neonate appears comfortable. Auscultation of the heart reveals a continuous ‘machinery-like’ murmur and a left-sided thrill. The apex beat is palpable and appears to be heaving. A widened pulse pressure is observed, but there is no visible cyanosis. An echocardiogram is performed and confirms the diagnosis while ruling out other cardiac issues.
What is the most appropriate course of action for management at this stage, given the likely diagnosis?

MSFinals-4555

A mother brings her 3-year-old son to see the GP as his walk has changed. She explains that he started walking shortly after 13 months old. She has noticed that, over the last 3 days, his walking has been different. There is no history of trauma.

The GP assesses him and notices an asymmetric gait. He appears well otherwise and basic observations are within normal limits. He is up-to-date with his immunisations and is developing normally.

What would be the most suitable course of action to take next?

MSFinals-4556

A 2-year-old girl is brought to the emergency department by her father due to pain in her left hip and a new limp. She has no past medical history except for a recent cold she had 2 weeks ago, from which she has recovered. There is no history of trauma to the hip. Her developmental milestones have been normal so far.

Upon examination, she is not running a fever. She tolerates slight movement of her left hip, but excessive motion causes her to cry.

The following investigations were conducted:
– Hemoglobin (Hb) level: 125 g/L (normal range for females: 110-140)
– Platelet count: 220 * 109/L (normal range: 150 – 400)
– White blood cell (WBC) count: 9.5 * 109/L (normal range: 4.0 – 11.0)

What is the most appropriate next step in managing this patient?

MSFinals-4521

A 4-week-old baby has been brought in by his mother after she is concerned about his movement. He is diagnosed as having developmental dysplasia of the hip on ultrasound.
Which statement is correct regarding the management of developmental dysplasia of the hip?

MSFinals-4522

A 6-year-old Chinese boy is brought to the Emergency Department by his parents because his skin and face turned blue after playing with his friends. The boy was born in China, and soon after his birth he and his parents moved to the United Kingdom. An ultrasound examination revealed a large gap in the upper portion of the ventricular septum and a slightly enlarged right ventricle. The doctor explained to the parents the severity of the disease and the importance of a surgical intervention.
If the parents decide not to go ahead with surgery to correct this condition, which of the following is most likely to happen to their child in the future?

MSFinals-4523

A 6-year-old child is brought to see you by his parents, who are concerned because he wets his bed every night. A urine culture is normal; urine is negative for glucose and protein.
What would be the most appropriate approach to managing this child’s bedwetting?