Archives: Medical Student Finals

MSFinals-3729

A 68-year-old retired banker is referred to the Urology Clinic with a 4-month history of poor stream when passing urine. Over the past few weeks, the patient has also noticed some blood in his urine.
He is normally fit and well. The only medical history of note is type 2 diabetes, which is well controlled with diet alone.
On rectal examination, the patient is noted to have an enlarged, irregularly shaped prostate.
A raised level of which of the tumour markers below would be most commonly associated with carcinoma of the prostate?

MSFinals-3730

A 67-year-old woman presented to the Oncology Clinic with chronic cough with haemoptysis, she has a long standing heavy smoking history. A bronchoscopy was performed which showed a tumour confined to the left main bronchus. A biopsy was taken and showed small cell lung cancer. She then had a staging computed tomography (CT) scan which showed a TNM grading of T2, N1, M0. She does not have any other medical co-morbidities and is usually independent in all daily activities.
Which of the following is the most appropriate management?

MSFinals-3731

A 55-year-old woman presents with symptoms of nausea and vomiting. She has been diagnosed with inoperable cancer and is experiencing pain from infiltration of the posterior abdominal wall. Currently, her pain is being managed effectively with Kapake (codeine 30 mg and paracetamol 500 mg), taken two tablets four times per day.

What is the optimal approach for managing her pain?

MSFinals-3732

A 22-year-old male patient presents to the Emergency department after ingesting an unknown quantity of paracetamol tablets. What is the ideal time to evaluate his paracetamol level to determine if treatment with n-acetylcysteine is necessary?

MSFinals-3733

A 65-year-old woman presents to the Emergency Department feeling generally unwell, with fever and a cough. She had chemotherapy for her breast cancer 4 days ago. There are no known drug allergies. On examination:
Investigation Result Normal value
Blood pressure (BP) 108/70 < 120/80 mmHg
Heart rate (HR) 101 60–100 beats/min
Respiratory rate (RR) 26 12–18 breaths/min
Sats 96% on air 94–98%
Temperature 38.7ºC 36.1–37.2°C
There is some scattered crepitations at the right lung base. You check on the system and see that bloods were done 2 days ago, and showed:
Investigation Result Normal value
Haemoglobin 120 g/l 115–155 g/l
White cell count (WCC) 3.1 × 109/l 4–11 × 109/l
Neutrophils 0.8 × 109/l 1.7–7.5 × 109/l
Lymphocytes 1.5 × 109/l 1.0–4.5 × 109/l
Eosinophils 0.6 × 109/l 0.0–0.4 × 109/l
Which of the following is the most appropriate next-step management?

MSFinals-3735

A 36-year-old patient with breast carcinoma is discovered to have a 1.5 cm tumour in the upper outer quadrant (OUQ) of her left breast. One local axillary node is positive, and no metastases are detected on imaging.
What is the accurate TNM (Tumour, Nodes, and Metastases) staging for her?

MSFinals-3702

The pathologist observed a lymph node biopsy under a microscope and found that the lymph node morphology was completely effaced by scattered malignant cells. These cells were identified as Reed-Sternberg cells and were large and binucleated. Given these findings, what is the most probable pathological diagnosis?

MSFinals-3703

A 56-year-old retired man with a history of chronic hepatitis B infection presents with jaundice and significant abdominal distention. The patient does not drink, and smokes ten cigarettes a day.
On examination, the patient is found to have ascites and hepatomegaly. The patient is admitted for further investigations; the results of one tumour marker test is suggestive of a possible hepatocellular carcinoma (HCC).
Which of the following tumour markers is usually raised in primary HCC?

MSFinals-3704

A 6-year-old girl is brought to the Paediatric Outpatient Department by her father with symptoms of bloating, mild fever, abdominal pain, lack of appetite, generalised feeling of being unwell and easy bruising for the past two weeks. On examination, hepatosplenomegaly, lymphadenopathy (non-tender, firm, rubbery) and patches of petechiae and purpura are noted on both lower limbs.
The child is referred to the Oncology Department where complete laboratory investigations, including full blood count (FBC), differential count and a review of the peripheral smear, were performed. The findings are indicative of acute lymphocytic leukaemia (ALL).
Which of the following would be the most likely finding with the suspected diagnosis?