Archives: Medical Student Finals

MSFinals-2840

A 65-year-old patient visits her GP complaining of back pain that is relieved by lying down. She has no history of trauma but had a hysterectomy at the age of 38 due to obstetric complications. Additionally, she has a history of poorly controlled asthma. Her FRAX® score indicates a 10-year fracture risk of 16%, prompting her GP to arrange a DEXA scan and relevant blood tests. The results show a calcium level of 1.8 mmol/L (2.1-2.6), vitamin D level of 17.2 ng/ml (≥20.0), phosphate level of 1.2 mmol/L (0.8-1.4), and a T-score of -3.2. What is the most appropriate next step in managing her condition?

MSFinals-2841

A 68-year-old woman presents with sudden-onset back pain that improves with lying down. She has a history of ulcerative colitis, for which she has just finished a course of steroids following a flare, went through menopause 15 years ago, and has not had symptoms of it since. Her BMI is 20 kg/m².

Blood tests are taken and an x-ray confirms a vertebral compression fracture. A FRAX® score is calculated to be 12% and a dual-energy x-ray absorptiometry (DEXA) scan is arranged which shows the following:

Calcium 2.3 mmol/L (2.1-2.6)
Vitamin D 18.2 ng/ml (≥20.0)
T-score -2.6

What is the most appropriate next step in her management?

MSFinals-2842

A 49-year-old female without significant medical history was diagnosed with deep vein thrombosis without any known risk factors or precipitating events. The patient was successfully treated with dalteparin and subsequent thrombophilia screening revealed moderately elevated anticardiolipin antibodies on two separate occasions, twelve weeks apart. What is the most suitable long-term plan for managing this patient?

MSFinals-2844

A 38-year-old man is seen for a follow-up appointment 3 weeks after sustaining a wrist injury from a fall onto outstretched hands. Imaging studies reveal a fracture of the scaphoid bone. What is the most common sign associated with this diagnosis?

MSFinals-2845

A 58-year-old man, with a history of acromegaly, presents with a swollen, red, hot, and painful right knee that developed over the past three days. He denies having a fever and was previously healthy. He receives monthly octreotide for his acromegaly and does not take any diuretics. An X-ray reveals chondrocalcinosis. What results would you anticipate from the joint fluid microscopy?

MSFinals-2846

A 50-year-old office worker visits the doctor complaining of a painful right elbow. He indicates the medial epicondyle of the humerus as the source of pain. Although he cannot recall any previous injury, he reports that the pain worsens when he uses his arm, and it can extend to his forearm. As a result, he has stopped playing tennis. Apart from this, he is healthy and not taking any medications.

Based on the patient’s history, the doctor suspects a specific diagnosis. What finding during the examination would be most indicative of this suspected diagnosis?

MSFinals-2847

An 80-year-old woman visits your clinic after experiencing a fall in her kitchen last week. She was evaluated in the emergency department and was found to have some bruising, but no fractures. She expresses concern about the possibility of falling again and the risk of future fractures. You recommend an evaluation of her fracture risk. What would be the most suitable method for assessing her fracture risk?

MSFinals-2848

A 35-year-old man of African origin visits his doctor with a complaint of experiencing extremely cold and white fingers at random times of the day, especially in winter and outdoors. During the examination, the doctor observes small white deposits on his arms, a large number of spider naevi on his cheeks, and thickened skin on the top of his hands, making it difficult for him to straighten out his fingers. Currently, the color and temperature of his fingers are normal. Based on the probable diagnosis, which of the following symptoms is most likely to be present?

MSFinals-2849

A patient who has been on peritoneal dialysis for six years contacts the clinic with concerns. The patient reports infusing 1.5 litres of fluid into their abdomen but only being able to remove 1 litre at the end of their dwell. However, the patient is not experiencing any symptoms and does not have ankle oedema.

What could be causing this issue?