Archives: Medical Student Finals

MSFinals-2883

A 32-year-old smoker presents with acute shortness of breath and oxygen saturation of 84% on air. He has been feeling unwell and fatigued for a week, with worsening shortness of breath over the past 24 hours and two episodes of haemoptysis. On examination, he has sinus tachycardia, a blood pressure of 140/85 mmHg, normal JVP, and widespread coarse crackles on chest auscultation. Blood tests reveal a haemoglobin level of 92 g/L (130-180), urea level of 40 mmol/L (2.5-7.5), and creatinine level of 435 μmol/L (60-110). The urine dipstick shows +++ blood and ++ protein. A chest radiograph shows widespread patchy opacification. What is the most likely cause of his presentation?

MSFinals-2884

What distinguishes haemodialysis from haemofiltration as methods of renal replacement therapy?

MSFinals-2885

You are part of the transplant team on call and have been asked to assess a potential kidney donor. The patient is an 86-year-old man who has been in the ICU for ten days due to severe pneumonia. He has required ventilatory support, inotropes, and filtration during his stay. His creatinine levels have rapidly risen since admission, with a current level of 350 umol/l. However, a sample taken six months ago by his GP showed a creatinine level of 95 umol/l. The patient’s medical history includes hypertension and a malignant melanoma that was treated to remission three years ago with a hemicolectomy, but no adjuvant therapy was required. His screening colonoscopies have been normal in the years since.

What factor would lead you to decide against this patient as a potential donor?

MSFinals-2886

A 50-year-old woman undergoing haemodialysis for end stage renal failure caused by vesico-ureteric reflux is experiencing a dry, flaky skin and an itchy rash. What is the probable complication of end stage renal failure responsible for these symptoms?

MSFinals-2887

A 25-year-old man is brought to the Emergency department by his friends after being found on the floor following a night out. There are suspicions that he may have taken drugs, although the exact substance is unknown. Upon examination, he is found to be semi-conscious with a rapid respiratory rate. A catheterisation procedure yields 25 mls of dark brown coloured urine which tests positive for haemoglobin using urinalysis.

What potential blood and electrolyte imbalances should be anticipated in this patient?

MSFinals-2888

A 59-year-old man is undergoing his routine dialysis treatment when he suddenly experiences intense chest pain and difficulty breathing. He has been on dialysis for the past nine years and uses a fistula for the procedure. So far, there have been no issues with the dialysis machine or circuit. After the session, his blood pressure is 150/85 mmHg, and an ECG is performed. What could be the probable reason for his chest pain?

MSFinals-2889

A patient in their late 60s with end stage renal disease on haemodialysis is admitted with sudden onset of wheezing and shortness of breath. They have swollen ankles and a raised JVP of 7 cm, with a blood pressure of 110/50 mmHg. Upon chest examination, there are widespread coarse crackles. A chest radiograph reveals complete opacification of both lung fields and blunting of the left costophrenic angle. The patient had their usual haemodialysis session the previous night. What could be the potential cause of this acute presentation?

MSFinals-2890

A 55-year-old male patient complains of swelling and is diagnosed with nephrotic syndrome. What is a frequently occurring complication of this condition?

MSFinals-2891

A 65-year-old woman with known CKD stage 4 due to type 2 diabetes and obesity is admitted with cellulitis that has not responded to oral antibiotics. MRSA is detected in swabs, and she is started on IV vancomycin. She is also taking carbamazepine, omeprazole, warfarin, and chloramphenicol eye drops. Three days later, the laboratory urgently calls to report her vancomycin level is 54 (therapeutic range 10-20), and regular dosing is immediately stopped. What is the most likely cause of her elevated levels?

MSFinals-2892

A patient who has been on peritoneal dialysis for three weeks has reported that despite instilling a full 2 litre bag of fluid, he only gets 1.9 litres back. Additionally, he has noticed swelling in his abdomen and tenderness upon palpation. What could be the probable cause of these issues?