Archives: Medical Student Finals

MSFinals-2934

In the treatment of autoimmunity and to prevent rejection following solid organ transplantation, there are various immunosuppressant drugs available. Despite their effectiveness, these drugs come with unwanted side effects, such as an increased risk of infection and malignancy. However, specific side effects may vary depending on the drug’s mechanism of action. Which immunosuppressant drug is linked to an elevated risk of bladder cancer in the long run and can cause haemorrhagic cystitis? Additionally, is this drug safe for use in elderly patients?

MSFinals-2935

A 25-year-old woman with a history of glomerulonephritis is scheduled to undergo a 24-hour urinary protein collection. What is the recommended starting time for the collection?

MSFinals-2936

A 63-year-old man was diagnosed with granulomatosis with polyangiitis (GPA) two years ago and achieved remission after receiving pulsed cyclophosphamide. He has been maintained on oral azathioprine and a low dose of prednisolone since then. Recently, he returned to the clinic before his scheduled appointment with worsening ENT symptoms, haemoptysis, and declining renal function. Two months prior, he had a superficial bladder cancer (stage Ta, no invasion, single lesion) that was resected, followed by a single dose of postoperative chemotherapy. Given his new diagnosis, what is the most appropriate treatment for his vasculitis flare?

MSFinals-2937

A 45-year-old man presents to the Emergency department with a general feeling of being unwell. He has no history of chronic disease or renal impairment. Upon blood testing, his results show elevated levels of creatinine, urea, potassium, creatine kinase, and phosphate, as well as a slightly low sodium level and an elevated CRP level. What could be the possible cause of his renal impairment?

MSFinals-2905

A 47-year-old patient arrives at the dialysis center for their thrice-weekly haemodialysis. They have end stage renal failure caused by membranous glomerulonephritis and no other health issues. The patient reports feeling fatigued but is otherwise in good health. During routine blood work, their haemoglobin level is found to be 89 g/L (115-165). If the anaemia is a result of their renal disease, what is the appropriate treatment for this patient?

MSFinals-2906

Which patient has a creatinine level indicating CKD3?

Patient A:
Adjusted calcium – 2.3 mmol/L
Phosphate – 0.9 mmol/L
PTH – 8.09 pmol/L
Urea – 7.8 mmol/L
Creatinine – 145 μmol/L
Albumin – 36 g/L

Patient B:
Adjusted calcium – 2.9 mmol/L
Phosphate – 2.0 mmol/L
PTH – 4.2 pmol/L
Urea – 50 mmol/L
Creatinine – 280 μmol/L
Albumin – 38 g/L

Patient C:
Adjusted calcium – 2.0 mmol/L
Phosphate – 2.8 mmol/L
PTH – 12.53 pmol/L
Urea – 32.8 mmol/L
Creatinine – 540 μmol/L
Albumin – 28 g/L

Patient D:
Adjusted calcium – 2.5 mmol/L
Phosphate – 1.6 mmol/L
PTH – 2.05 pmol/L
Urea – 32.8 mmol/L
Creatinine – 367 μmol/L
Albumin – 40 g/L

Patient E:
Adjusted calcium – 2.2 mmol/L
Phosphate – 0.7 mmol/L
PTH – 5.88 pmol/L
Urea – 4.6 mmol/L
Creatinine – 81 μmol/L
Albumin – 18 g/L

MSFinals-2907

As a locum GP, you have been presented with blood results for five patients you have never met before. Your task is to review the results and identify which patient is likely to have nephrotic syndrome. The results are as follows:

Patient A: Adjusted calcium – 2.3 mmol/L, Phosphate – 0.9 mmol/L, PTH – 8.09 pmol/L, Urea – 7.8 mmol/L, Creatinine – 132 μmol/L, Albumin – 36 g/L.

Patient B: Adjusted calcium – 2.9 mmol/L, Phosphate – 0.5 mmol/L, PTH – 7.2 pmol/L, Urea – 5 mmol/L, Creatinine – 140 μmol/L, Albumin – 38 g/L.

Patient C: Adjusted calcium – 2.0 mmol/L, Phosphate – 2.8 mmol/L, PTH – 12.53 pmol/L, Urea – 32.8 mmol/L, Creatinine – 540 μmol/L, Albumin – 28 g/L.

Patient D: Adjusted calcium – 2.5 mmol/L, Phosphate – 1.6 mmol/L, PTH – 2.05 pmol/L, Urea – 32.8 mmol/L, Creatinine – 190 μmol/L, Albumin – 40 g/L.

Patient E: Adjusted calcium – 2.2 mmol/L, Phosphate – 0.7 mmol/L, PTH – 5.88 pmol/L, Urea – 4.6 mmol/L, Creatinine – 81 μmol/L, Albumin – 18 g/L.

It is important to note that the normal values for each of these parameters are also provided. With this information, you must determine which patient is likely to have nephrotic syndrome.

MSFinals-2908

As a locum GP, you are tasked with reviewing blood results for five patients you have never met before. The following results have been provided for each patient:

Patient A: Adjusted calcium – 2.3 mmol/L, Phosphate – 0.9 mmol/L, PTH – 8.09 pmol/L, Urea – 7.8 mmol/L, Creatinine – 132 μmol/L, Albumin – 36 g/L

Patient B: Adjusted calcium – 2.9 mmol/L, Phosphate – 0.5 mmol/L, PTH – 7.2 pmol/L, Urea – 5 mmol/L, Creatinine – 140 μmol/L, Albumin – 38 g/L

Patient C: Adjusted calcium – 2.0 mmol/L, Phosphate – 2.8 mmol/L, PTH – 12.53 pmol/L, Urea – 32.8 mmol/L, Creatinine – 540 μmol/L, Albumin – 28 g/L

Patient D: Adjusted calcium – 2.5 mmol/L, Phosphate – 1.6 mmol/L, PTH – 2.05 pmol/L, Urea – 32.8 mmol/L, Creatinine – 190 μmol/L, Albumin – 40 g/L

Patient E: Adjusted calcium – 2.2 mmol/L, Phosphate – 0.7 mmol/L, PTH – 5.88 pmol/L, Urea – 4.6 mmol/L, Creatinine – 81 μmol/L, Albumin – 18 g/L

Your task is to identify which patient is likely to have CKD 5.

MSFinals-2909

Which patient has abnormal blood results that suggest they may have myeloma?

Patient A:
Adjusted calcium – 2.3 mmol/L
Phosphate – 0.9 mmol/L
PTH – 8.09 pmol/L
Urea – 7.8 mmol/L
Creatinine – 132 μmol/L
Albumin – 36 g/L
Total protein – 77 g/L

Patient B:
Adjusted calcium – 2.9 mmol/L
Phosphate – 0.5 mmol/L
PTH – 7.2 pmol/L
Urea – 5 mmol/L
Creatinine – 140 μmol/L
Albumin – 38 g/L
Total protein – 68 g/L

Patient C:
Adjusted calcium – 2.8 mmol/L
Phosphate – 1.2 mmol/L
PTH – 0.45 pmol/L
Urea – 7.2 mmol/L
Creatinine – 150 μmol/L
Albumin – 28 g/L
Total protein – 88 g/L

Patient D:
Adjusted calcium – 2.5 mmol/L
Phosphate – 1.6 mmol/L
PTH – 2.05 pmol/L
Urea – 32.8 mmol/L
Creatinine – 190 μmol/L
Albumin – 40 g/L
Total protein – 82 g/L

Patient E:
Adjusted calcium – 2.2 mmol/L
Phosphate – 0.7 mmol/L
PTH – 5.88 pmol/L
Urea – 4.6 mmol/L
Creatinine – 81 μmol/L
Albumin – 18 g/L
Total protein – 55 g/L

MSFinals-2910

As a locum GP, you have been presented with blood results for five patients you have never met before. The results are as follows:

Patient A: Adjusted calcium – 2.8 mmol/L, Phosphate – 0.9 mmol/L, PTH – 8.09 pmol/L, Urea – 7.8 mmol/L, Creatinine – 132 μmol/L, Albumin – 36 g/L.

Patient B: Adjusted calcium – 2.9 mmol/L, Phosphate – 0.5 mmol/L, PTH – 7.2 pmol/L, Urea – 5 mmol/L, Creatinine – 140 μmol/L, Albumin – 38 g/L.

Patient C: Adjusted calcium – 2.0 mmol/L, Phosphate – 2.8 mmol/L, PTH – 12.53 pmol/L, Urea – 32.8 mmol/L, Creatinine – 540 μmol/L, Albumin – 28 g/L.

Patient D: Adjusted calcium – 2.5 mmol/L, Phosphate – 1.6 mmol/L, PTH – 2.05 pmol/L, Urea – 32.8 mmol/L, Creatinine – 190 μmol/L, Albumin – 40 g/L.

Patient E: Adjusted calcium – 2.2 mmol/L, Phosphate – 0.7 mmol/L, PTH – 5.88 pmol/L, Urea – 4.6 mmol/L, Creatinine – 81 μmol/L, Albumin – 18 g/L.

Your task is to identify which patient is likely to have acute kidney injury (AKI). Take your time to carefully review the results and make an informed decision.