Archives: Medical Student Finals

MSFinals-2762

A 50-year-old woman presents with progressive weakness and fatigue. She experiences difficulty standing for prolonged periods and struggles to rise from a seated position. Upon examination, her hands appear excessively dry and cracked, with rough erythematous papules and plaques present on the extensor surfaces of her fingers. Additionally, there is reduced power in her hips and shoulders. The patient has a history of anxiety and frequently washes her hands due to fear of spreading germs during the COVID-19 pandemic. She has also been a heavy smoker for the past 30 years, consuming 40 cigarettes per day.

What is the most appropriate course of action for managing this patient’s condition?

MSFinals-2763

A 68-year-old woman presents with acute lower back pain of one week duration. The pain is localized to her lower back, rates 9/10 in severity, and has not improved with paracetamol and ibuprofen. She has a medical history significant for stage 3 chronic kidney disease, hypertension, osteoporosis, and hypercholesterolemia. The patient has a 30-pack-year smoking history and is currently taking bendroflumethiazide, amlodipine, alendronic acid, vitamin D supplements, calcium tablets, omeprazole, and atorvastatin. On physical examination, the patient has lumbar lordosis, decreased mobility, and spasm of the paravertebral muscles. Tenderness to palpation is noted at L4-L5. A previous DEXA scan taken 6 months ago shows a T-score of −3.0 in the lumbosacral spine and −3.2 in the left hip. What is the recommended first-line investigation?

MSFinals-2764

A 67-year-old woman visits her GP complaining of left-sided headaches that have been occurring intermittently for the past two weeks. She reports that her vision in the left eye has worsened over the last two days and appears blurrier than usual. The patient has a medical history of hypertension, which is well-managed with ramipril. During the examination, the GP notes tenderness in the left temporal region with reproducible pain when the patient chews. There are no abnormalities found during external eye examination. What is the underlying pathology responsible for this patient’s visual disturbance?

MSFinals-2765

A 48-year-old woman is seen in rheumatology clinic for her rheumatoid arthritis. Despite trying various medications, she has not experienced much relief from her symptoms. The rheumatologist decides to prescribe hydroxychloroquine for her.
What are the potential adverse effects that the patient should be informed about?

MSFinals-2766

You see a 14-year-old boy with his father. He is normally completely fit and well and extremely active. He is a keen soccer player and also enjoys running. He noticed a lump behind his left knee one week ago, it seemed to come on suddenly. He can’t remember ever injuring his knee. It is not painful but his knee does feel ‘tight’.

On examination, he has a round, soft fluctuant mass behind his left knee in the medial popliteal fossa. It is approximately the size of a baseball. The swelling feels tense in full knee extension and soften again or disappear when the knee is flexed. Flexion is slightly reduced.

What is the most likely diagnosis here?

MSFinals-2767

A 35-year-old woman presents to her GP complaining of numbness and tingling in both hands, particularly at night. Upon examination, there is no weakness in finger flexion, extension, or abduction, but there is weakened pincer grip. Bilateral mild wasting of the thenar eminence is observed, and both Tinel’s and Phalen’s signs are positive in both hands. Based on her medical history, which of the following conditions is most likely to have predisposed her to this condition?

MSFinals-2768

A 65-year-old male is receiving his last round of ICE chemotherapy for non-Hodgkin’s lymphoma. What is the potential risk associated with his treatment that he may develop?

MSFinals-2769

A 72-year-old Afro-Caribbean woman presents to the hospital with a neck of femur fracture after slipping at her local supermarket. The orthopaedic SHO takes her medical history, which reveals that she has a history of ischaemic heart disease and rheumatoid arthritis. She went through menopause at 55 and was an avid jogger until the fall. Following surgical management of the fracture, a DEXA scan is performed, which shows a T score of -2.9, indicating osteoporosis. What aspect of the patient’s medical history is most strongly linked to an increased risk of osteoporosis?

MSFinals-2770

Samantha is a 42-year-old woman who visits her GP complaining of a burning pain on the outer part of her left knee. The pain is felt during movement and she has not observed any swelling of the knee. There is no history of injury and no locking of the knee joint. Samantha is a long-distance runner and is preparing for a marathon. During examination, there is tenderness on palpation of the lateral aspect of the joint line. She has a good range of motion of her knee joint. However, a snapping sensation is noticed on the lateral aspect of the knee when her joint is repeatedly flexed and extended. What is the most probable diagnosis?

MSFinals-2771

A 50-year-old woman comes to the clinic complaining of joint pain in her right hand that has been bothering her for the past 6 months. Upon examination, there is tenderness in the distal interphalangeal joints of her right hand. An X-ray reveals erosions in the center of the distal interphalangeal joints of her right hand, which are described as having a pencil in cup appearance. What is the probable diagnosis?