Archives: Medical Student Finals

MSFinals-6536

A 45-year-old man presents with a sudden thunderclap headache while seated. On examination, he exhibits signs of meningism such as a stiff neck and photophobia, but no fever. A CT scan is inconclusive and rules out SAH. Despite this, you decide to perform a lumbar puncture 12 hours later. What CSF findings would confirm the presence of SAH in this patient?

MSFinals-6537

A 63-year-old man presents with persistent diarrhoea and abdominal pain. During the past week, he experienced several days of reduced bowel movements. Upon further questioning, he admits to occasional blood in his stools.

On examination, his heart rate is 86 bpm and his temperature is 37.9ºC. There is tenderness in the lower left quadrant. He is admitted and treated. A CT chest, abdomen, and pelvis reveals mural thickening of the colon and pericolic fat stranding in the sigmoid colon.

What lifestyle recommendations can aid in managing the probable diagnosis?

MSFinals-6538

A 45-year-old male is set to undergo a laparoscopic cholecystectomy tomorrow afternoon. The patient is diabetic and takes gliclazide twice daily. He inquires if he can continue taking his medication leading up to the surgery.
What guidance should the doctor provide?

MSFinals-6539

Which of the following haemodynamic changes is not observed in hypovolaemic shock?

MSFinals-6540

A 50-year-old patient on your practice list has a BMI of 52 kg/m² and is interested in bariatric surgery. There are no co-morbidities or contraindications for surgery.

What should be the next course of action?

MSFinals-6542

A 25-year-old woman presents to her GP with a lump on her left breast. She has no family history of breast cancer. Upon examination, a smooth, rubbery, mobile mass measuring 4 cm in diameter with clearly defined edges is found. An ultrasound of her breasts reveals a single round solid mass of 4 cm diameter, which is well circumscribed and lobulated. Core biopsy confirms the presence of epithelial and stromal elements consistent with a fibroadenoma. The lump is causing her moderate discomfort and she expresses a desire to have it removed. What is the most appropriate advice to give this patient?

A) The lump will regress by itself so no need to remove.
B) The lump is non-cancerous and hence cannot be removed, but she should return if it changes or grows.
C) Refer her for excision biopsy to remove the mass.
D) Prescribe her ibuprofen for the pain, and advise her that she does not require removal of the lump.
E) Refer her for a breast mammogram to assess the lump.

Explanation:
As the lump has examination, ultrasound, and histological findings consistent with a fibroadenoma and is causing moderate discomfort, surgical excision should be recommended. It is important to obtain histological evidence to confirm the diagnosis of fibroadenoma if excision is required. Observation and simple advice would be sufficient if the fibroadenoma were less than 3 cm, but the size and discomfort of this lump make that option incorrect. A breast mammogram is usually ineffective for a younger woman due to dense breasts. Prescribing ibuprofen is generally the treatment for fibroadenosis, which is a different condition where women experience painful breasts generally around their periods. It would not be a solution for the discomfort caused by the mass effect of the fibroadenoma.

MSFinals-6543

A 55-year-old man complains of lower back pain, painful urination, and low-grade fevers for the past 3 days. During the examination, the physician noted a tender, boggy prostate and diffuse pain in the lower abdomen. A urine dip test revealed 2+ blood in the urine. What is the recommended treatment for the suspected diagnosis?

MSFinals-6544

A 78-year-old man presents to his primary care physician with bothersome urinary symptoms. He reports difficulty with urination, including a weak stream and the need to strain. These symptoms are causing increased pain in his abdominal incisional hernia. Additionally, he experiences significant post-void dribbling, requiring the use of incontinence pads.

Upon examination, the physician notes a significantly enlarged prostate that is smooth with a clear median sulcus. A urine dipstick test is unremarkable. The patient’s blood test reveals a prostate-specific antigen level of 1 ng/mL (normal range <4 ng/mL). What is the most appropriate course of treatment for this patient?

MSFinals-6545

A 62-year-old male comes to the clinic complaining of pain during bowel movements for the past 4 days. Upon examination, a tender, oedematous, and purple subcutaneous mass is found at the anal margin. What is the most appropriate course of action for this patient?