Archives: Medical Student Finals

MSFinals-3696

A 68-year-old woman with a history of stage III endometrial cancer and mucinous pancreatic cancer presents to the Emergency Department with severe abdominal pain. The pain has been ongoing for the last four weeks but has worsened in the last three days as she has run out of her analgesia. She denies nausea or vomiting and she has been opening her bowels regularly. She has not been able to get an appointment with the general practitioner so that the pain medication could be prescribed. She was admitted to a hospice last week for end-of-life care.
Examination reveals a distended abdomen. There is shifting dullness present. Bowel sounds are present. The abdomen is mildly tender to touch. Her legs are also oedematous.
Which of the following is the most appropriate step in management?

MSFinals-3697

A 70-year-old woman comes to the clinic with a lump in her neck. She is anxious because her sister was diagnosed with a highly aggressive type of thyroid cancer that is prevalent in older adults and has a poor prognosis. What type of cancer is she talking about?

MSFinals-3698

A 78-year-old man with advanced dementia and oesophageal cancer is rushed to the hospital from a nursing home due to sudden onset of complete dysphagia. He cannot tolerate any food or drink and immediately vomits. He had a stent placed two weeks ago which initially provided relief. Physical examination shows no abnormalities. What is the probable diagnosis?

MSFinals-3699

What is the most common way in which a child with Wilms’ tumour presents?

MSFinals-3700

A 78-year-old man with advanced adenocarcinoma of the colon and extensive pulmonary metastases reports experiencing breathlessness recently. He notices this when he takes just a few steps away from his bed. Despite trying controlled breathing techniques, he finds no relief from his breathing difficulties.
What is the next appropriate course of action for managing dyspnoea in this patient?

MSFinals-3675

A woman is in labour with her first child. The midwife becomes concerned that the cardiotocograph is showing late decelerations. She is reviewed by the obstetrician on-call who states that there is fetal compromise, but no immediate risk to life. A category two caesarean section is planned.

What is the timeframe for the delivery to be performed?

MSFinals-3676

A 35-year-old woman who is 32 weeks pregnant with twins comes to you complaining of intense pruritus that has been affecting her sleep for the past 4 days. She has multiple excoriations but no visible skin rash. The pregnancy has been uneventful, and foetal movements are normal.
Her blood tests show:
– Bilirubin 38 µmol/L (3 – 17)
– ALP 205 u/L (30 – 100)
– ALT 180 u/L (3 – 40)
An abdominal ultrasound shows no abnormalities.
What is the most likely diagnosis, and what management plan would you recommend?

MSFinals-3677

A 28-year-old G3P2 woman at 32 weeks gestation presents to the emergency department with sudden and severe lower abdominal pain that started 45 minutes ago. She reports a small amount of vaginal bleeding but her baby is still active, although movements are slightly reduced. She has had regular antenatal care and her medical history is unremarkable, except for a 10 pack-year smoking history. Her two previous children were born vaginally and are healthy at ages 4 and 6.

The patient is alert and oriented but in significant pain. Her vital signs are within normal limits except for a blood pressure of 150/95 mmHg and a heart rate of 120 beats per minute. A cardiotocograph shows a normal baseline fetal heart rate with appropriate accelerations and no decelerations.

What is the most likely diagnosis and what is the next appropriate step in management?

MSFinals-3678

A 25-year-old woman is experiencing labour with a suspected case of shoulder dystocia and failure of progression. What is the Wood’s screw manoeuvre and how can it be used to deliver the baby?

MSFinals-3679

A 55-year-old man presented with non-specific abdominal discomfort lasting for 8 months. Physical examination revealed no lymphadenopathy, abdominal masses or organomegaly, and bowel sounds were present. A stool sample tested negative for occult blood. Imaging with abdominal CT revealed a 22-cm retroperitoneal soft tissue mass that was obstructing the left psoas muscle. What is the most probable neoplasm in this case?