Archives: Medical Student Finals

MSFinals-3011

A 35-year-old man presents to the doctor’s office with complaints of double vision, drooping eyelids, and difficulty with speaking, chewing, and swallowing. He reports feeling well in the morning without weakness, but as the day progresses, he experiences increasing fatigue and weakness. Additionally, he notes muscle weakness after exercise that improves with rest. On physical examination, there is no muscle fasciculation, atrophy, or spasticity, and all reflexes are normal. Sensation is intact, and his pupils are equal and reactive to light. What autoantibodies are responsible for this patient’s condition?

MSFinals-3012

A 46-year-old alcoholic is brought in after a fall. He has a deep cut on the side of his head and a witness tells the paramedics what happened. He opens his eyes when prompted by the nurses. He attempts to answer questions, but his speech is slurred and unintelligible. The patient pulls away from a trapezius pinch.
What is the appropriate Glasgow Coma Scale (GCS) score for this patient?

MSFinals-3013

A 65-year-old man has experienced three instances of temporary blindness in his right eye. He has a regular heart rate of 88 beats per minute in sinus rhythm. What is the most suitable test to diagnose the condition?

MSFinals-3014

A 75-year-old retired teacher presents with acute-onset confusion. The patient lives alone and is usually in good health. She has had no issues with her memory before, but over the past three days, her neighbor has noticed that the patient has become increasingly confused; this morning she did not recognize her own home. When taking the history from the neighbor, she mentions that the patient had been experiencing urinary symptoms over the past week. A dipstick of the patient’s urine is positive for blood, leukocytes and nitrites. A tentative diagnosis of delirium secondary to a urinary tract infection (UTI) is made, and empirical treatment for UTI is initiated.
Which of the following tests is typically abnormal during delirium, regardless of the cause?

MSFinals-2987

A 78-year-old retired pharmacist is diagnosed with Alzheimer’s disease after being investigated for worsening memory problems and getting lost on his way home from the shops. What is associated with a diagnosis of Alzheimer’s disease?

MSFinals-2988

A 68-year-old man with Parkinson’s disease comes in with sudden shaking, vertigo, and upward eye movement. What could be the probable reason for his abrupt onset?

MSFinals-2989

A 70-year-old man presents to his General Practitioner (GP) with worsening right foot drop over two months. He also states that he has begun to drop objects that he was previously able to lift with ease and feels that both of his hands are constantly shaking. He does not have any other medical conditions. He recalls that his brother and father passed away from a neurological disease, of which he does not know the name.
Examination reveals bilateral lower limb weakness. There is hyperreflexia on examination of the knees and ankles. Plantars are upgoing. Examination of the upper limb is pertinent for left arm weakness, in particular in the median and ulnar nerve-innervated hand muscles. Sensation is normal in both upper and lower limbs. A diagnosis of motor neurone disease (MND) (amyotrophic lateral sclerosis) is being considered.
Which of the following medications is most likely to improve the life expectancy of this patient?

MSFinals-2990

A patient aged 50 presents to the ENT clinic with facial pain. The patient reports experiencing frequent attacks of pain around the left eye and left cheek, with up to 15-20 attacks per day. The attacks are short, lasting 3-4 minutes but can last up to 15 minutes, and can be triggered by neck movements. The patient also experiences watering of the left eye during the attacks. There are no associated symptoms of vomiting, aversion to light or sound, or limb weakness. Both ear, nose, and throat and neurological examinations are normal, and the patient is normotensive. What is the most likely diagnosis?

MSFinals-2991

A 60-year-old woman is referred by her general practitioner for investigation of a headache. On further questioning, she reports a 2- to 3-week history of worsening left-sided pain which is most noticeable when she brushes her hair. She also reports that, more recently, she has noticed blurred vision in her left eye. On examination, she has stiffness of her upper limbs, as well as tenderness to palpation over her left scalp and earlobe. Her past medical history is notable for hypothyroidism.
Which is the diagnostic test of choice?

MSFinals-2992

A 28-year-old motorcyclist is brought to the Emergency Department (ED) 45 minutes after a collision with a heavy-goods vehicle. Immediately after the collision she was unconscious for three minutes. Since regaining consciousness, she appears dazed and complains of a headache, nausea and ringing in her ears, and she is aversive to light and sound. Prior to examination she had an episode of vomiting.
An ABCDE assessment is performed and the results are below:
Airway Patent, able to speak
Breathing Respiratory rate (RR) 18 per min, SaO2 97% on room air, normal and symmetrical chest expansion, normal percussion note bilaterally, normal vesicular breath sounds throughout
Circulation Heart rate (HR) 97/min, blood pressure (BP) 139/87 mmHg, capillary refill time (CRT) <2 s, ECG with sinus tachycardia, normal heart sounds without added sounds or murmurs
Disability AVPU, pupils equal and reactive to light, Glasgow Coma Scale (GCS) = 13 (E4, V4, M5), no signs suggestive of basal skull fracture
Exposure Temperature 36.8 °C, multiple bruises but no sites of external bleeding, abdomen is soft and non-tender
Which of the following would be appropriate in the further management of this patient?