Archives: Medical Student Finals

MSFinals-3172

A patient presents to the General Practice (GP) Clinic, seeking advice regarding driving following two unprovoked seizures in 48 hours. What advice do you give the patient regarding their ability to drive their car?

MSFinals-3174

A 65-year-old female presents with a three month history of headaches, shoulder pain and weight loss. Over this time she has lost approximately 6 kg in weight.

She describes early morning stiffness of the shoulders. Also, she has become aware of frontal headaches and has noticed tenderness of the scalp particularly when she combs her hair. She has little in her past medical history, she is a lifelong non-smoker and takes no medication.

During examination, she appears to be in good health with a blood pressure of 126/88 mmHg and a BMI of 23.4. Neurological examination is normal though she is tender over the shoulders and scalp.

Which of the following investigations would you select for this patient?

MSFinals-3175

A 35-year-old woman presents to the general practice clinic with a complaint of headache for the past few months. She reports feeling a tight band-like sensation all over her head, which is present most days but has not interfered with her work. She experiences fatigue due to the headache but denies any associated nausea or vomiting. She occasionally takes paracetamol and ibuprofen, which provide some relief. What is the most probable diagnosis?

MSFinals-3176

A 59-year-old man presents to your clinic with a 6-month history of experiencing ‘tingling’ in his wrists and hands at night, with the right side being more affected than the left. Upon examination, you observe atrophy of the thenar eminence of his right hand. He displays slight weakness in thumb opposition and reduced sensation to light touch on the palmar surface of his right hand on the lateral three digits and the lateral half of the fourth digit. Reproduction of his symptoms occurs when you tap immediately distal to the wrist joint of his right hand for about 30 s.
Which nerve is implicated in this man’s condition?

MSFinals-3177

A 76-year-old retired teacher is being evaluated for progressive memory impairment. Based on the information provided by the patient’s spouse, the clinician suspects that the patient may have vascular dementia.
What are the typical features of vascular dementia?

MSFinals-3178

A woman is being evaluated for a chronic cranial nerve lesion in the outpatient clinic. She has no facial weakness, and examination of the eyes reveals a full range of movement. She reports no difficulties with vision, smell, taste, hearing or balance, and facial and pharyngeal sensation is normal. Her gag reflex is present and normal, and she can shrug her shoulders equally on both sides. Her speech is slurred and indistinct, and on protruding her tongue, it deviates to the right side and there is notable fasciculation and atrophy of the musculature on the right.
With what are these findings most likely to be associated?

MSFinals-3179

If a corticospinal tract lesion occurs above the nuclei of cranial nerves, what neurological signs would be anticipated?

MSFinals-3180

A 25-year-old student presents to her general practitioner because of a tremor she has noticed in her left hand over the past few months. On examination, she has subtle dysarthria and a wide-based gait. When the doctor passively moves her left elbow, he notices hypertonia which is independent of whether he moves her elbows slowly or briskly. She has a history of bipolar disorder and was started on olanzapine by her psychiatrist 2 weeks ago.
Which of the following diagnostic tests is most appropriate to confirm the diagnosis?

MSFinals-3181

You see a 92-year-old lady in clinic. Over the past 3 months, her family believes she is becoming more forgetful. She has also noticed a tremor in her right hand and is generally ‘slowing down’. She takes amlodipine for hypertension and a daily aspirin of her own volition. She has recently been treated for a urinary tract infection by her general practitioner. She also complains of confusion and seeing spiders climbing the walls of her bedroom. She has no other urinary complaints. Her abbreviated mental test score is 5/10. Lying and standing blood pressures are 138/76 and 127/70, respectively.
Select the most likely diagnosis from the list below.