Archives: Medical Student Finals

MSFinals-3001

A 28-year-old woman presents to her primary care physician with concerning symptoms that have been occurring on and off for the past few months. She reports experiencing episodes of weakness accompanied by rapid, involuntary movements of her arms. Additionally, she has been experiencing persistent tingling sensations, occasional double vision, electric shocks down her arms and trunk when she flexes her neck, and constipation. Based on these symptoms, what would be the most appropriate initial test to diagnose her condition?

MSFinals-3002

What impact would a voltage-gated calcium channel inhibitor have on action potentials in the central nervous system?

MSFinals-3003

A 68-year-old man is admitted to the Emergency Department having been picked up by a patrolling police car. He was found wandering around a roundabout in his nightgown, and when stopped, had no recollection of where he lived or of his own name. A mini-mental assessment reveals that he is disorientated to time and place and has poor memory. Physical examination is unremarkable. A full history is taken following contact with his wife and she reports that her husband has been suffering from worsening memory and cognition. A differential diagnosis includes dementia. Investigations are requested.
What is the most common cause of dementia in the United Kingdom?

MSFinals-3004

A 25-year-old, fit and healthy woman develops severe headache, confusion and nausea on day 5 of climbing Mount Kilimanjaro in her adventure trip. A doctor accompanying the group examines her and finds her to be tachycardic with a raised temperature. They diagnose high-altitude cerebral oedema.
What is the most crucial step in managing this patient?

MSFinals-3005

A 40-year-old woman presents to your clinic with complaints of difficulty reading, which she has noticed over the past two weeks. She has never worn glasses and is not taking any medications.

Upon examination, her pupils are of normal size but react sluggishly to light. Both optic discs appear sharp, without signs of haemorrhages or exudates. However, her visual acuity is significantly impaired and remains so even when using a pinhole card. Additionally, she exhibits five-beat nystagmus and double vision when looking to the left.

What is the most likely diagnosis for this patient?

MSFinals-3006

A 38-year-old office worker is becoming increasingly worried that she may be experiencing early signs of Alzheimer’s disease, which her mother was diagnosed with at a young age. She reports frequently misplacing her phone and struggling to recall names of colleagues she has worked with for years. She wants to learn more about the initial clinical features of the disease to see if they align with her symptoms.

What is a typical clinical characteristic of the early stage of Alzheimer’s disease?

MSFinals-3007

A 20-year-old female underwent an appendicectomy and was administered an antiemetic for her nausea and vomiting. However, she is now experiencing an oculogyric crisis and has a protruding tongue. Which antiemetic is the most probable cause of her symptoms?

MSFinals-3009

An 85-year-old man presents with a short history of increasing confusion. Preceding this, he fell four weeks ago in the bathroom. In the afternoon he was examined by his GP and he was alert with a normal physical examination. The patient has a history of hypertension for which he takes bendroflumethiazide.

Four weeks later the patient was visited at home because the dazed state had returned. He is afebrile, has a pulse of 80 per minute regular and blood pressure of 152/86 mmHg. His response to questions is slightly slowed, he is disoriented in time and there is some deficit in recent memory.

The patient moves slowly, but muscle strength is preserved. Neurologic examination shows slight hyperactivity of the tendon reflexes on the right. Plantar responses are unclear because of bilateral withdrawal. That gives him a GCS score of 14.

What would be the most appropriate next investigation for this 85-year-old man?

MSFinals-3010

A 65-year-old woman presents with a history of facial pain and diplopia. Clinical examination reveals CN III, CN IV and CN VI palsies, a Horner’s syndrome, and facial sensory loss in the distribution of the V1 (ophthalmic) and V2 (maxillary) divisions of the trigeminal cranial nerve.
Where is the causative abnormality located?