Archives: Medical Student Finals

MSFinals-2862

A 49-year-old man underwent a kidney transplant two years ago due to end stage renal failure caused by ANCA associated vasculitis. He recently visited the clinic with complaints of sweating palms, weight loss, insomnia, and tremors. Upon conducting thyroid function tests, an undetectable TSH and a free T4 of 25 mg/dL (NR 4.5-11.5) were observed. The patient was diagnosed with Graves’ disease after testing positive for thyroid stimulating hormone receptor (TSH-R) antibodies. Which medication could have potentially contributed to this condition?

MSFinals-2863

A 44-year-old woman underwent a kidney transplant four years ago due to end stage renal failure caused by lupus nephritis. The transplant was from her sister, and she received anti-thymocyte globulin (ATG) induction and plasma exchange pre-transplant due to low-grade donor specific antibodies. She has been stable on tacrolimus, mycophenolate mofetil and prednisolone, with only one episode of acute cellular rejection at six months post-transplant. During her four-year follow-up, she presented with a creatinine level of 150 umol/l and high blood pressure at 150/95 mmHg, which increased to 160 umol/l in a repeat sample one month later. She was admitted for further investigations and biopsy, which revealed double contouring of the glomerular capillary basement membrane, without inflammatory infiltrate and negative C4d. Donor specific antibodies were still present, but titres were low. What is the most likely diagnosis?

MSFinals-2864

A 28-year-old female presents with acute kidney injury and pulmonary haemorrhage, and is diagnosed with anti-GBM disease (Goodpasture’s disease) with very high antibody titres. She is started on plasma exchange with daily treatments for five days in addition to methylprednisolone. What is a complication of plasma exchange that is unlikely to occur?

MSFinals-2865

A 42-year-old previously healthy teacher visits her doctor complaining of headache and itching. During her urine test, protein (3+) and blood (1+) are detected, but there are no splinter haemorrhages. What other bedside examination would be beneficial in evaluating her condition?

MSFinals-2834

A 27-year-old male presented to the emergency department after sustaining a shoulder dislocation during a game of football. The medical team reduced his shoulder and immobilized it with a sling. During the examination, the doctor assessed the sensation in the ‘regimental badge area’ and found it to be normal. Which nerve is frequently affected in cases of shoulder joint dislocation, and which nerve was the doctor testing for in this scenario?

MSFinals-2835

A 25-year-old man who suffered from distal radial fracture eight weeks ago visits his GP complaining of numbness in the lateral three and a half digits and atrophy of the thenar muscles. What is the probable diagnosis?

MSFinals-2836

A 36-year-old teacher presents to the emergency department with a complaint of shin pain that has been bothering her for the past 2 months. The pain is specifically located over the tibia and is relieved by rest. However, she is worried as she has a hiking trip planned for the weekend. She has not undergone any hospital investigations yet. On examination, there is diffuse tenderness over the tibia. She expresses her apologies for coming to the emergency department, stating that her GP could not offer an appointment for the next 2 weeks and she needs advice before the weekend.

What is the next step in managing this patient?

MSFinals-2837

A 29-year-old man is brought to the emergency department following a head-on collision with his motorcycle. He is conscious and responsive, but he reports severe agony in his right leg. Upon examination, there is an exposed break in the right tibia with significant damage to the surrounding soft tissue and contamination. The medical team has administered intravenous antibiotics. What is the primary treatment for his fracture?

MSFinals-2838

A 28-year-old basketball player presents with difficulty moving after an injury during a game. He reports hearing a ‘popping’ sound when the incident occurred and experienced a sudden onset of severe pain in the back of his right leg.

Clinical examination showed swelling of the right calf and no movement of his right foot whilst squeezing the corresponding calf, whilst lying face down on the examining bench.

What is the most appropriate initial investigation to request for this patient?

MSFinals-2839

A middle-aged Bangladeshi man presents to the emergency department with back pain and fever. An MRI is performed and a diagnosis of discitis is made. A CT guided biopsy is performed and cultures were taken. They come back showing Staphylococcus aureus as the causative organisms and antibiotic therapy was started based on sensitivity testing. 2 weeks later he returns to the emergency department as he has spiked another fever and the back pain is worsening.

What could be the reason for the deterioration of symptoms in this middle-aged Bangladeshi man with discitis despite antibiotic therapy?