Archives: Medical Student Finals

MSFinals-2911

Which patient has an elevated PTH level that is indicative of primary hyperparathyroidism?

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

MSFinals-2912

A patient who has been on peritoneal dialysis for two years complains that her bags, previously clear, have become cloudy.

She is in good health, with slight abdominal discomfort, and has successfully instilled fluid, although she only removed 1.5 liters from a 2-liter bag instilled earlier. Her abdomen is soft and only slightly tender.

What is the probable complication?

MSFinals-2913

A 50-year-old woman presents to the rheumatology clinic with joint pain, weight loss, a vasculitic rash, and overall fatigue. Upon examination, she has elevated inflammatory markers, blood and protein in her urine, and positive MPO ANCA antibodies. She is urgently referred to renal physicians and undergoes a renal biopsy, which reveals crescentic glomerulonephritis. The diagnosis is microscopic polyangiitis. What is the most suitable initial treatment?

MSFinals-2914

A 45-year-old woman who suffers from chronic back pain and takes regular doses of paracetamol and ibuprofen has been diagnosed with proteinuria at a level of 900 mg/24 hours. Upon further examination, it was discovered that her urine contains small proteins with minimal amounts of albumin. What could be the probable reason for her proteinuria?

MSFinals-2915

A 7-year-old girl presents with oedema and proteinuria of 4.2 g/24 hours. She is diagnosed with minimal change disease and started on steroid therapy. What could be the possible reason for her proteinuria?

MSFinals-2916

Are there any immunosuppressant drugs that can cause severe myelosuppression along with unpleasant gastrointestinal side effects? It is important to note that while all immunosuppressants have potential side effects such as increased risk of infection and malignancy, certain drugs may have specific side effects due to their unique mechanisms of action.

MSFinals-2917

A 60-year-old woman has been referred to the hypertension clinic due to her two-year history of hypertension and current use of chlorthalidone. Her physician suspects that there may be an underlying secondary cause for her hypertension and wants to investigate further. During her clinic visit, she mentions recent illness with gastroenteritis. Blood tests taken today show a renin level of 120 pmol/l (normal range: 10-60) and an aldosterone level of 1215 pmol/l (normal range: 100-800). What is the most likely explanation for these results?

MSFinals-2918

A 60-year-old patient presents to her GP with a general feeling of unwellness. The following blood test results are obtained:

– Adjusted calcium: 2.9 mmol/L (normal range: 2.2-2.4)
– Phosphate: 0.5 mmol/L (normal range: 0.7-1.0)
– PTH: 7.2 pmol/L (normal range: 1.05-6.83)
– Urea: 5 mmol/L (normal range: 2.5-7.8)
– Creatinine: 140 µmol/L (normal range: 60-120)
– 25 OH Vit D: 50 nmol/L (optimal level >75)

What is the most likely diagnosis?

MSFinals-2919

A 35-year-old male was given steroids after a kidney transplant. After two years, he experienced hip pain and difficulty walking. What is the most probable cause of his symptoms?

MSFinals-2920

A patient admitted for treatment of PD peritonitis has had their cloudy PD fluid sent for culture and has been started on empirical antibiotics while awaiting results. What is the most probable pathogen responsible for the infection?