Archives: Medical Student Finals

MSFinals-3065

A 51-year-old man is admitted at the request of his concerned family due to increased confusion. This has occurred over the past 3 months and has become steadily worse. He was living independently and had been an active local councillor. Now he is unable to identify his family members.
Examination findings: pleasantly confused, intermittent jerky movements of both upper arms.
The following investigations were performed:
CT brain: normal
Dementia screen: normal
Which one of the following diagnostic tests will assist most in diagnosis?

MSFinals-3066

A 65-year-old woman comes to her GP complaining of frequent falls and unsteadiness on her feet for the past 2 days. During the examination, the GP observes weakness and loss of sensation in the muscles of her right lower limb, while her upper limbs and face show no sensory deficit or weakness. The GP refers her to the nearest stroke unit for further evaluation and treatment. A CT scan confirms a thromboembolic cerebrovascular accident.

Which vessel is the most probable culprit?

MSFinals-3067

A 65-year-old woman presents to her general practitioner (GP) with unsteadiness on her feet and frequent falls of two days’ duration.
On examination, she is noted to have loss of sensation and weakness of the proximal and distal muscles of the left lower limb. Her upper limbs and face have no weakness or sensory deficit.
Her GP refers her to the nearest Stroke Unit for assessment and management. Computed tomography (CT) scan confirms a thromboembolic cerebrovascular accident.
Which vessel is most likely to have been involved?

MSFinals-3035

A 68-year-old man presents to the general practitioner (GP) with visual complaints in the right eye. He intermittently loses vision in the right eye, which he describes as a curtain vertically across his visual field. Each episode lasts about two or three minutes. He denies eye pain, eye discharge or headaches.
His past medical history is significant for poorly controlled type 2 diabetes mellitus, hypertension and hypercholesterolaemia.
On examination, his pupils are of normal size and reactive to light. There is no scalp tenderness. Blood test results are pending, and his electrocardiogram (ECG) shows normal sinus rhythm, without ischaemic changes.
A provisional diagnosis of amaurosis fugax (AG) is being considered.
Given this diagnosis, which of the following is the most appropriate treatment at this time?

MSFinals-3036

A 75-year-old retired teacher is brought to the general practitioner (GP) by her concerned son. He tells you that his mother had got lost when returning home from shopping yesterday, a trip that she had been carrying out without problems for over 20 years. He also notes that she has had a general decline in her memory function over the past year or so, frequently repeating stories, and not being able to remember if she had eaten a meal or not that day when questioned. The son would like to know if his mother could be tested for Alzheimer’s disease, a condition that also affected her maternal grandmother.

Deposition of which of the following is associated with the development of Alzheimer’s disease?

MSFinals-3037

A 68-year-old retired electrical engineer had a gradual decline in initiating and performing voluntary movements. His face was expressionless and he had tremors, which were particularly obvious when he was sat idle watching tv. He also showed a marked decrease in blinking frequency but had no evidence of dementia.
What is the most probable diagnosis associated with these symptoms?

MSFinals-3038

A 2-day-old infant is diagnosed with an intraventricular haemorrhage. What is commonly linked with this diagnosis?

MSFinals-3039

A 29-year-old man presents to the Emergency Department with his friend after collapsing during a soccer match. He fell to the ground suddenly, losing consciousness. Witnesses reported jerking movements of his limbs and incontinence before the episode self-terminated after a few minutes. He has a history of psoriasis and takes methotrexate once weekly. He is urgently referred to a Neurology Clinic for review. Physical examination is normal, and investigations reveal no abnormalities except for a slightly elevated TSH level. What is the most likely cause of his presentation?

MSFinals-3040

A 72-year-old woman with a history of rheumatoid arthritis, hypertension and depression has been experiencing severe pins and needles in her hands upon waking in the morning. The patient has worked as a stenographer for the last 25 years, and this sensation has been increasing in intensity over the past 7 years.
What would be the anticipated findings for this patient based on her medical history and symptoms?

MSFinals-3041

A 50-year-old man has been experiencing severe periorbital headaches on the right side for the past two weeks. These headaches occur at least once a day, often at night, and last for about an hour. He has also noticed tearing from his right eye and blockage of his right nostril during the headaches. However, at the time of examination, he was not experiencing any headache and there were no physical abnormalities. What is the most probable diagnosis for this patient?