Archives: Medical Student Finals

MSFinals-3121

A 52-year-old woman presents to her general practitioner (GP), complaining of bleeding gums every time she brushes her teeth. She reports that this is very concerning to her and has gotten to the point where she has stopped brushing her teeth.
Her past medical history is significant for hypertension, for which she takes lisinopril. She takes no anticoagulants or antiplatelet medication.
Her observations are as follows:
Temperature 37.1°C
Blood pressure 140/90 mmHg
Heart rate 68 bpm
Respiratory rate 16 breaths/min
Oxygen saturation (SpO2) 98% (room air)
Examination of the oral cavity reveals red, swollen gingiva, with bleeding easily provoked with a periodontal probe.
Which of the following is the next best step?

MSFinals-3122

A 68-year-old man visits the Elderly Care Clinic with his wife. He has a medical history of Parkinson’s disease, which has been under control with various medications. However, his wife is concerned as he has been exhibiting abnormal behavior lately, such as spending a considerable amount of their savings on a car and making inappropriate sexual advances towards his elderly neighbor. Which medication is the probable cause of this man’s change in behavior?

MSFinals-3101

A senior citizen visits her physician with a complaint of painful sensation on the outer part of her thigh. The doctor diagnoses her with meralgia paraesthetica.
Which nerve provides sensation to the lateral aspect of the thigh?

MSFinals-3102

A 32-year-old woman complains of numbness and ‘pins and needles’ in her left leg that has been present for 48 h after a long flight. On examination, there is reduced sensation to light touch at the lateral aspect of her left thigh, extending from the iliac crest to the knee. There is no distal sensory loss. There is preserved motor function through all muscle groups of the affected limb. There is no weakness or sensory change in the opposite limb.
What is the most likely anatomical source for this woman’s presentation?

MSFinals-3088

A 48-year-old man presents with slurred speech. Upon examination, he displays bilateral partial ptosis and frontal balding. Additionally, he experiences difficulty releasing his grip after shaking hands. What is the probable diagnosis?

MSFinals-3089

A 79-year-old man is brought to see his general practitioner by his daughter who has noticed that he is becoming increasingly forgetful and unsteady on his feet. Unfortunately his daughter does not know anything about his previous medical history or whether he takes any medications. Routine investigations reveal:
Investigation Result Normal Value
Haemaglobin 105 g/l 135–175 g/l
Mean corpuscular value 101 fl 76–98 fl
White cell count 7.2 × 109/l 4–11 × 109/l
Platelets 80 × 109/l 150–400 x 109/
Sodium 132 mmol/l 135–145 mmol/l
Potassium 4.8 mmol/l 3.5–5.0 mmol/l
Urea 1.3 mmol/l 2.5–6.5 mmol/l
Creatinine 78 μmol/l 50–120 µmol/l
Random blood sugar 6.1 mmol/l 3.5–5.5 mmol/l
Given these results, which is the most likely cause of his symptoms?

MSFinals-3090

A 25-year-old law student complains that she cannot fall asleep until 0330 h. She sleeps through morning classes, frequently waking up at about 1100 h.
What is the most likely diagnosis?

MSFinals-3091

A 31-year-old man visits the Neurology Clinic accompanied by his brother. He reports experiencing episodes of confusion and amnesia that typically last for a few minutes. His brother has observed him suddenly stopping what he is doing and staring into space on several occasions. The patient presents a video of one such episode, which shows lip-smacking and chewing. He has no recollection of these incidents, but he has noticed the smell of burning and a strange sense of déjà vu on multiple occasions. There is no indication of tongue biting or limb jerking. The patient is in good health, but he admits to regularly using cannabis. What is the most probable cause of these occurrences?