Archives: Medical Student Finals

MSFinals-6503

A 57-year-old woman without medical history presents to the emergency department complaining of severe abdominal pain and vomiting that has been ongoing for 12 hours. Upon examination, she is found to be tender in the epigastrium and has a low-grade fever. An abdominal ultrasound reveals the presence of gallstones, but no signs of cholecystitis. Blood tests are ordered and show the following results:

– Hb: 121 g/L (normal range: 115 – 160)
– Platelets: 450 * 109/L (normal range: 150 – 400)
– WBC: 15.5 * 109/L (normal range: 4.0 – 11.0)
– Calcium: 1.9 mmol/L (normal range: 2.1-2.6)
– Amylase: 1056 U/L (normal range: 70 – 300)
– Bilirubin: 5 µmol/L (normal range: 3 – 17)
– ALP: 92 u/L (normal range: 30 – 100)
– ALT: 33 u/L (normal range: 3 – 40)
– γGT: 41 u/L (normal range: 8 – 60)
– Albumin: 32 g/L (normal range: 35 – 50)

As she awaits transfer to the ward, the patient’s condition worsens. She becomes increasingly short of breath and tachypnoeic, and eventually develops central cyanosis. What is the most likely cause of her deterioration?

MSFinals-6505

A 70-year-old male visits his GP complaining of perineal pain, haematuria and urinary hesitancy that has persisted for 2 months. During a digital rectal examination, the physician notes an enlarged prostate gland with a loss of the median sulcus. The patient’s PSA level is reported as 14.1ng/mL (normal range: 0-5.5 ng/mL). What is the initial investigation recommended for this patient?

MSFinals-6506

What is the probable diagnosis for a 24-year-old man who twisted his knee during a football match, continued to play, but now experiences increasing pain, swelling, and intermittent locking two days later?

MSFinals-6507

A 67-year-old man visits his GP complaining of pain in his buttocks. The vascular team is consulted as they suspect he may have peripheral arterial disease. He experiences pain while walking, which subsides within 2 minutes of resting, but reports no pain in his calves. Angiography is recommended. Which vessel is most likely affected based on his symptoms?

MSFinals-6508

A 78-year old man taking alendronic acid presents with a painful lower left arm after falling at home. An x-ray shows a fracture of the distal radius with dorsal displacement of the distal fragment. What is the medical term for this type of fracture?

MSFinals-6509

A 25-year-old woman presents to the surgical assessment unit with a complaint of severe, slow onset pain in her left iliac fossa. Upon examination, left iliac fossa pain is confirmed, and she denies being sexually active. However, there is some clinical evidence of peritonitis. What investigation should be requested next?

MSFinals-6510

A 70-year-old man presents with a painful swelling on his left calf that appeared a few days ago. He denies any history of trauma and is otherwise healthy with well-controlled hypertension. On examination, there is a tender, inflamed mass under the skin with mild erythema but no signs of cellulitis or DVT. The patient is afebrile and all vital signs are normal. The suspected diagnosis is uncomplicated superficial thrombophlebitis. What is the most appropriate management plan, in addition to analgesia?

MSFinals-6511

You review a 62-year-old man who presents with a gradual history of worsening fatigue and denies any other symptoms. He has no medical history and takes no medication. Routine observations are within normal limits and there are no abnormalities on thorough examination.

You perform a set of blood tests which come back as below:

Hb 118 g/L Male: (135-180) Female: (115 – 160)

Platelets 395* 109/L (150 – 400)

WBC 10.9* 109/L (4.0 – 11.0)

Na+ 140 mmol/L (135 – 145)

K+ 3.7 mmol/L (3.5 – 5.0)

Urea 6.9 mmol/L (2.0 – 7.0)

Creatinine 110 µmol/L (55 – 120)

Ferritin 17 ng/mL (20 – 230)

Vitamin B12 450 ng/L (200 – 900)

Folate 5 nmol/L (> 3.0)

What would be your next steps in managing this patient?

MSFinals-6512

A 50-year-old man presents to his GP with concerns about erectile dysfunction. He has been experiencing this for the past year and is feeling embarrassed and anxious about it, as it is causing issues in his marriage. On examination, the GP notes that the patient is overweight with a BMI of 27 kg/m2, but does not find any other abnormalities. The GP orders HbA1c and lipid tests. What other steps should the GP take at this point?

MSFinals-6515

A 28-year-old male patient visits his GP complaining of a painless lump in his scrotum. He admits to not regularly performing self-examinations and reports no other symptoms. Upon examination, his left testicle is enlarged. The GP orders a two-week-wait ultrasound scan of the testicles, which reveals a cystic lesion with mixed solid echoes in the affected testicle. What tumor marker is linked to this condition?