Archives: Medical Student Finals

MSFinals-2901

A 40-year-old male presents with weakness in his left upper and both lower limbs for the last six months. He developed digital infarcts involving his second and third toes on his left side and the fourth toe on his right side.

On examination, his blood pressure was 170/110 mmHg, all peripheral pulses were palpable and there was an asymmetrical neuropathy.

Investigations showed:

– Haemoglobin 118 g/L (120-160)
– White cell Count 11 ×109/L (3.5-10)
– Platelets 420 ×109/L (150-450)
– ESR 55mm/hr (0-15)

Urine examination showed proteinuria +++ and RBC 10-15/hpf without casts.

What is the most likely diagnosis?

MSFinals-2902

A 30-year-old woman visits her doctor complaining of pharyngitis and is prescribed amoxicillin for a week. She also requests a refill of her oral contraceptive pill, bendroflumethiazide, lansoprazole, and naproxen, which she has been taking for the past nine months due to a skiing injury.

After three weeks, she returns to the doctor with joint pains and a mild rash. Blood tests reveal a creatinine level of 356 µmol/L and an eosinophilia of 1.7 ×109/L (NR 0-0.4). The doctor refers her to renal services with a suspected diagnosis of tubulointerstitial nephritis.

Which medication is the most likely cause of her symptoms?

MSFinals-2903

A 14-year-old girl presents with proteinuria at 1500 mg/24 hours. Upon examination, her urine reveals the presence of significant amounts of large proteins, including albumin and transferrin. What could be the possible reason for her proteinuria?

MSFinals-2904

A 50-year-old man visits his doctor with symptoms of a vasculitic rash, joint pains, and swollen ankles. He reports feeling unwell, fatigued, and experiencing weight loss. During the visit, his urine dipstick shows blood and protein, and urgent blood tests reveal worsening kidney function with elevated inflammatory markers. The doctor suspects microscopic polyangiitis and requests an autoimmune screening. What autoantibody is expected to be positive in this case?

MSFinals-2897

A 35-year-old man visits the renal clinic eight weeks after a successful renal transplant. He has some inquiries about his immunosuppression. The consultant explains that the typical regimen for renal transplant patients involves the use of an induction agent initially, followed by a combination of a calcineurin inhibitor, antimetabolite, and steroids. This combination is intended to prevent rejection of the transplanted kidney. Can you identify the agent that acts as a purine analogue to disrupt DNA synthesis and induce apoptosis in rapidly dividing cells?

MSFinals-2898

As a GP, you come across a 42-year-old man who had an incidental discovery of hyperlipidaemia during a recent insurance medical examination at work. His test results showed cholesterol levels of 22 mmol/L (ideal <5 mmol/L) with triglycerides of 18 mmol/L (<1.5 mmol/L). He is generally healthy but has low albumin and peripheral oedema. Upon conducting a urinalysis, the results are as follows: Haemoglobin: Negative
Urobilinogen: Negative
Bilirubin: Negative
Protein: +++
Glucose: Negative
Nitrites: Negative
Leucocytes: Negative
Ketones: +

What could be the possible explanation for these findings?

MSFinals-2900

A 28-year-old female patient complains of epistaxis and has been experiencing a fever. Upon examination by an ENT specialist, she was found to have serous otitis media. Further tests revealed protein +++ and 20 RBC/hpf in her urine, while her serum rheumatoid factor was negative. What is the most probable diagnosis for this patient?

MSFinals-2881

A 40-year-old woman presents to the hypertension clinic with a blood pressure reading of 185/95 mmHg and grade 1 hypertensive retinopathy. She has no known medical history. What clinical or biochemical finding could indicate a potential diagnosis of primary hyperaldosteronism?

MSFinals-2882

What is the primary role of the kidneys in eliminating waste in a person who is in good health?