Archives: Medical Student Finals

MSFinals-6612

A 26-year-old female patient arrives at the emergency department complaining of left-sided flank pain that has been ongoing for two hours. The pain radiates down towards her groin and is constant, unaffected by changes in position. She reports feeling nauseous and has vomited once. The patient has no significant medical history and is not taking any regular medications.

Upon examination, the patient is tender over the left costovertebral angle and shows signs of guarding, but no rebound tenderness. Her vital signs are heart rate 112/min, blood pressure 120/76 mmHg, temperature 38.1ºC, respiratory rate 14/min, and saturations 97%. An ultrasound scan of the kidneys reveals dilation of the renal pelvis on the left, while a CT scan of the kidneys, ureters, and bladder shows a 4 mm stone in the left ureter. What is the most appropriate course of action?

MSFinals-6613

A 65-year-old man arrives at the emergency department with complaints of leg pain. Upon examination, the leg appears pale, there is no pulse felt below the knee, it feels very cold, and the patient is reporting severe excruciating pain that began an hour ago. What is the optimal approach to managing this condition?

MSFinals-6614

An 80-year-old woman is recovering on the surgical ward two days after undergoing hemicolectomy for colorectal carcinoma. She has been instructed to fast. Her epidural fell out about twelve hours after the surgery, causing her significant pain. Despite the on-call anaesthetist being unavailable for several hours, the epidural was eventually replaced. The next morning, you examine her and find that she is now pain-free but complaining of shortness of breath. Additionally, she has developed a fever of 38.2º. What is the most probable reason for her fever?

MSFinals-6615

A 50-year-old man is at his pre-operative assessment for his scheduled hernia repair next week. During the consultation, he informs the anaesthetist that his father and brother had a reaction to an anaesthetic in the past, which was later diagnosed as malignant hyperthermia.
What medication should the anaesthetist avoid administering in this situation?

MSFinals-6616

A 65-year-old patient has sustained a traumatic burn injury and requires emergency surgery. The patient’s electrolyte levels are as follows:
Na+ 131 mmol/l
K+ 5.9 mmol/l
Urea 8.1 mmol/l
Creatinine 78 µmol/l
The patient is being prepared for anesthesia. Which of the following neuromuscular blockers should be avoided in this case?

MSFinals-6617

A General Practitioner refers a 6-week-old infant to the neurosurgery clinic due to observing an exponential increase in the child’s head circumference. What signs would indicate that the infant is suffering from hydrocephalus?

MSFinals-6618

A 32-year-old man presents with a painful swollen groin. He has also noticed stinging on urination and some clear discharge coming from his penis. He is sexually active with his partner of 3 months.

On examination, his heart rate is 96/min, respiratory rate is 18/min, blood pressure is 129/74 mmHg, and temperature is 38.2ºC. The left testicle is tender and erythematosus but the pain is relieved on elevation.

What is the most appropriate first-line investigation for the most likely diagnosis?

MSFinals-6619

A 28-year-old woman presents to the breast clinic with a lump in her right breast that she has noticed for the past 4 weeks. She denies any pain, discharge, or skin changes. The patient is concerned about the lump as she has recently started a new relationship and her partner has also noticed it. On examination, a mobile, smooth, firm breast lump measuring 3.5 cm is palpated. Ultrasound confirms a fibroadenoma. What is the best course of action for this patient?

MSFinals-6620

A 75-year-old woman without other medical conditions is diagnosed with T2 HER2+ breast cancer. During clinical examination, palpable axillary lymph nodes are found, and a needle biopsy confirms nodal metastasis under ultrasound guidance. The patient firmly decides against any axillary surgery after discussing with the surgeon. What alternative non-surgical approach is available for managing the patient’s axillary metastases?

MSFinals-6621

A 72-year-old man visits his GP complaining of voiding symptoms but no storage symptoms. After being diagnosed with benign prostatic hyperplasia, conservative management proves ineffective. The recommended first-line medication also fails to alleviate his symptoms. Further examination reveals an estimated prostate size of over 30g and a prostate-specific antigen level of 2.2 ng/ml. What medication is the GP likely to prescribe for this patient?