Archives: Medical Student Finals

MSFinals-6568

A sixty-seven-year-old woman on a colorectal surgery ward is recovering from a left hemi-colectomy 5 days previously for a tumour in the descending colon. She is eating and drinking as normal and has been able to mobilise with a walking aid during her physiotherapy sessions.

During the night she complains to the nurse that she is experiencing palpitations and feels very unwell. She has no significant past medical history and no previous surgery prior to this operation. Following her initial assessment, the nurse contacts the foundation year one doctor on call to assess the patient.

On examination:

Heart rate: 124/minute and irregularly irregular; Respiratory rate: 16/minute; Temperature: 38.2 ºC; Blood pressure: 132/82 mmHg; Oxygen saturations levels: 98%; Capillary refill time: <2 seconds. Heart sounds normal. Lungs clear. Abdomen distended. Wound on left flank healing well. No erythema or suppurative exudate. Firm and non-tender. No organomegaly. Kidneys non-ballotable. No pulsatile mass. Bowel sounds absent. No renal bruit. There is feculent material present in the abdominal wound drain. What is the most likely cause of this patient’s symptoms?

MSFinals-6569

A 63-year-old man visits his doctor with concerns about his urine flow. He has noticed that it is not as strong as it used to be and he experiences some dribbling after he finishes. He does not have any strong urges to urinate and does not wake up at night to do so. He feels that he does not fully empty his bladder and is worried about these symptoms. The patient has a history of heart failure and smokes 10 cigarettes a day. He lives alone and has not had any previous surgeries. During a digital rectal examination, his doctor notes that his prostate feels hard and irregular. The patient’s blood test results from last week show a serum prostate-specific antigen level of 2.0 ng/ml. How should this patient’s condition be managed?

MSFinals-6570

A 56-year-old man visits your clinic with a complaint of altered bowel habit for the past 4 weeks. He also reports per rectal bleeding mixed with his stool, tenesmus after defecation, and a weight loss of 6 kilos in the last 8 weeks. Upon performing a PR examination, you detect a mass on the rectum’s posterior wall, approximately 10 cm from the anal verge. The mass is irregular and measures 9 cm in diameter. You suspect rectal cancer and order an urgent suspected cancer review and colonoscopy. If your suspicions are correct, what is the most probable diagnosis?

MSFinals-6572

A 22-year-old male patient comes to the clinic with a lump in his testicle. Upon examination, the mass is found to be painless, irregularly surfaced, hard, and about 2 cm in size. It does not transilluminate. What is the probable cause of the testicular lump?

MSFinals-6573

Which one of the following statements regarding testicular cancer is correct?

MSFinals-6574

A 23-year-old male presents to the emergency department with complaints of testicular pain. The pain has been gradually increasing over the past 24 hours and is localized to the left testicle. On examination, the patient appears uncomfortable. His heart rate is 68/min, blood pressure is 118/92 mmHg, respiratory rate is 18/min, and temperature is 38.5 ºC. The left testicle is swollen and erythematosus, and lifting the scrotal skin provides relief. There is no discharge reported. What is the most appropriate next step given the likely diagnosis?

MSFinals-6575

You are conducting an annual health review for a 60-year-old man who has hypertension, a history of myocardial infarction 18 months ago, and depression. He is currently taking amlodipine, ramipril, sertraline, atorvastatin, and aspirin. The patient reports feeling generally well, but he is experiencing erectile dysfunction since starting his medications after his heart attack. Which medication is most likely responsible for this symptom?

MSFinals-6576

Linda, a 55-year-old woman with COPD and a 45-pack-year history, recently underwent a hysterectomy for uterine fibroids. She received standard anesthesia induction with propofol and rocuronium, and maintenance with sevoflurane. During her postoperative recovery, she experienced apnea upon extubation and required a prolonged stay in the ICU until she could be weaned off the ventilator. Upon further questioning by the ICU doctor, Linda revealed that she had been experiencing double vision and weakness in her hands and fingers, which worsened throughout the day. She had attributed these symptoms to fatigue. What is the most likely cause of her prolonged reliance on the ventilator?

MSFinals-6578

A 73-year-old man is undergoing an elective transurethral resection of prostate (TURP) for benign prostatic hyperplasia with spinal anaesthesia. After 40 minutes into the procedure, he complains of headache and visual disturbances. A venous blood gas analysis is ordered, and the results show severe hyponatremia. What could be the reason for this presentation?