Archives: Medical Student Finals

MSFinals-2814

A 47-year-old Bangladeshi woman visits her GP complaining of feverish feelings and pains in multiple joints that have persisted for 3 months. She used to work as a nurse in Bangladesh until 8 months ago when she moved to the UK to live with her family. She also reports unintentional weight loss. During the examination, the GP observes signs of an asymmetrical polyarthritis, erythema nodosum on both shins, and firm, enlarged, painless cervical lymph nodes. The patient undergoes several tests, including screening blood tests and joint arthrocentesis with microscopy, culture, and sensitivity (MCS). The results show anti-CCP, RF, and ANA to be negative, CRP to be 31 mg/L (< 5), and no crystals or organisms seen in the MCS joint aspiration sample. What is the most probable cause of her polyarthritis?

MSFinals-2815

A 30-year-old woman presents with a swollen second toe and wrist pain associated with a 5 month history of generalised fatigue. She has no other symptoms including no skin changes, and no previous medical history. Her mother suffers from psoriasis. She had the following blood tests as part of her investigations.

Hb 125 g/l

Platelets 390 * 109/l

WBC 6.5 * 109/l

ESR 78 mm/h

Rheumatoid Factor Negative

Antinuclear Antibody Negative

What is the most likely diagnosis?

MSFinals-2816

A 29-year-old woman with rheumatoid arthritis has not responded to methotrexate and sulfasalazine and is now being considered for etanercept injections. What potential side effect is linked to the use of etanercept?

MSFinals-2801

A 63-year-old woman presents to her GP with a headache that started a week ago and is different from her usual headaches. She also reports experiencing jaw pain while eating, which has been ongoing for the past week. The GP suspects giant cell arthritis and initiates high-dose prednisolone treatment while referring her to ambulatory emergency care for specialist evaluation. The patient expresses concern about the potential impact of high-dose steroids on her bone health.
What is the best course of action for managing this patient’s condition?

MSFinals-2793

A 78-year-old woman is admitted from her nursing home after experiencing a fall resulting in a displaced intracapsular hip fracture. She has a history of hypertension, mild cognitive impairment, and osteoarthritis. Typically, she requires a zimmer frame for mobility and appears frail. What is the appropriate surgical approach for her condition?

MSFinals-2794

A 25-year-old male presents to the emergency department complaining of pain in his ankle. He reports that whilst playing basketball that evening he landed awkwardly on his left foot after jumping for a rebound. He felt a pop at the time of impact and his ankle immediately became swollen.

On examination:

Heart rate: 80/minute; Respiratory rate: 16/minute; Blood pressure: 120/80 mmHg; Oxygen saturations: 99%; Temperature: 36.8 ºC. Capillary refill time: 2 seconds.

Left ankle: swollen, erythematosus and disaffirmed. Skin intact. Extremely tender upon palpation of the lateral malleolus. Difficulty weight-bearing and dorsiflexing the ankle. Sensation intact. Pulses present.

Examination of the right ankle and lower limb is unremarkable.

X-rays of the left ankle and foot are carried out which demonstrate a fractured lateral malleolus and associated dislocation of the ankle joint.

What term is used to describe this pattern of injury?

MSFinals-2795

A 35-year-old intravenous drug user has been diagnosed with osteomyelitis of the right tibia. What organism is most likely responsible for this infection?

MSFinals-2796

A 56-year-old man comes to the emergency department complaining of a painful swollen knee that started 1 day ago. Upon examination, his right knee is warm to the touch, diffusely swollen, and erythematosus. There is pain on both active and passive movement, and flexion and extension are limited due to pain.
Observations show a respiratory rate of 18 breaths per minute, oxygen saturations of 99%, blood pressure of 131/86 mmHg, heart rate of 68 beats per minute, and a temperature of 38.1ºC.
Blood tests have been sent off for cultures and the results are pending.
What is the most likely causative organism for this diagnosis?

MSFinals-2797

A 25-year-old Sri Lankan male comes to you with a complaint of low back pain that has been gradually worsening over the past 6 months. He reports that the pain is particularly bad before he wakes up in the morning. Additionally, he has noticed increasing stiffness in his right wrist and left third metacarpal joints. Upon examination, you observe reduced spinal movements in lateral spinal flexion and rotation, as well as a positive Schober’s test. The patient has not received any prior treatment for his back pain and has no other medical history. What would be the most appropriate initial course of action?

MSFinals-2798

A 42-year-old man presents to orthopaedics complaining of knee pain that has been bothering him for the past day. Upon aspiration, gram stain reveals no organisms or crystals but a high number of white blood cells. As a medical professional, what would be your recommended course of action?

Upon further examination, the patient reports experiencing watery discharge and swelling in both eyes, as well as dysuria for several days. He discloses that he is sexually active with one partner and always uses protection. Additionally, he mentions having had a bout of diarrhea that lasted for four days, three weeks prior.