Archives: Medical Student Finals

MSFinals-6821

A 75-year-old woman is admitted to the Coronary Care Unit after being diagnosed with an inferior myocardial infarction. On day 2, she complains of sudden onset of severe pain in her left leg that started 30 minutes ago and is increasing in intensity. She has never had this kind of pain before and, prior to this admission, claims to have been extraordinarily well for her age. On examination, the leg is cool and pale in comparison to the right leg. Femoral pulses are present and of good volume; however, the pulse rhythm is noted to be irregular. The pulses in her right leg are all palpable. There are no pulses felt below the groin on the left leg.
Select the most appropriate diagnosis for this patient.

MSFinals-6826

A 33-year-old woman, a smoker, presents to the Emergency Department at 28 weeks’ gestation with a swollen left lower leg. She reported experiencing some pain and swelling in both legs in the past week, but woke up this morning with the left leg being tender and red.
Her medical history is unremarkable, but she is feeling short of breath and her vital signs are stable.
Upon examination, there is bilateral lower limb swelling, with the left side being significantly more swollen and painful upon palpation. The skin is also warm to the touch. An electrocardiogram (ECG) shows no abnormalities.
What is the initial step in managing this patient’s likely diagnosis?

MSFinals-6836

A 50-year-old woman had a traditional high tie, strip and avulsion procedure for her varicose veins in the distribution of the long and short saphenous veins. She experienced difficulty walking after the surgery because she could not dorsiflex or evert her foot. The surgeon had warned her beforehand that nerve damage was a possibility.
What nerve was affected during the patient’s varicose vein surgery?

MSFinals-6820

A 55-year-old man, with a known abdominal aortic aneurysm presents for his annual review.
What size abdominal aortic aneurysm (AAA) would indicate the need for urgent elective surgery of the aneurysm?

MSFinals-6831

A 68-year-old man presents to the surgical assessment unit with severe back pain that has been ongoing for several hours. He is an ex-smoker with a medical history of hypertension and hyperlipidaemia, and has undergone multiple surgeries for Crohn’s disease in the past. An urgent abdominal ultrasound is ordered, which reveals a 5.1 cm infrarenal abdominal aortic aneurysm (AAA). What would be the most suitable course of action?

MSFinals-6824

A 43-year-old man presents with intermittent claudication. He has a body mass index of 32 kg/m2 and smokes 40 cigarettes a day. He admits that he has an extremely unhealthy diet. There is no family history of cardiovascular disease but his father died of complications of diabetes. His blood pressure is 160/110 mmHg.
What is the most likely cause of the claudication?

MSFinals-6805

A 15-year-old presents with a tender, pea-sized lump in the upper pole of his left testis. He says it has developed gradually over the last 24 hours. His mum states that his grandfather died of testicular cancer at just 45 years of age. Other than pain from the lump, he says he feels generally well in himself. On examination, the lump does not transilluminate and feels regular. There is no associated oedema or erythema.
What is the most likely diagnosis?

MSFinals-6804

A 30-year-old man comes to the clinic with a testicular lump that has been present for a few weeks and is gradually getting bigger. He has no history of trauma and is not experiencing any other symptoms. He has no significant medical history or regular medications. During the examination, a solid 3 cm mass is found in the left testicle, along with widespread lymphadenopathy. The following are his blood test results:
Alpha-fetoprotein (αFP): 0.1 ng/ml (0-10 ng/ml)
Beta-human chorionic gonadotrophin (βHCG): 4,500 IU/l
Lactate dehydrogenase (LDH): 375 IU/l
What is the most probable diagnosis?

MSFinals-6806

A 28-year-old man and his 26-year-old wife visit their GP for a follow-up appointment regarding their difficulty in conceiving. The couple has been trying to conceive for the past year without success. The wife has a regular menstrual cycle and no previous gynaecological issues. An ovulation test measuring her progesterone level showed normal ovulation. The GP advises the couple that the husband needs to undergo tests to determine if there is any cause on his side contributing to the infertility. Both the man and the woman have no history of sexually transmitted infections. The man has been smoking one to two cigarettes a day since he was 16 years old. What is the best next investigation for this patient?

MSFinals-6808

A 65-year-old patient is referred to the Outpatient Clinic with raised prostate-specific antigen (PSA), but a normal prostate on physical examination. He is later diagnosed with prostate cancer on biopsy.
What is the most common area of the prostate where this disease develops?