Archives: Medical Student Finals

MSFinals-6458

A 68-year-old man presents to the emergency department with increasing pain in his right leg. He has had intermittent claudication for a few months but has had a sudden increase in pain since this morning. His past medical history is otherwise significant for 2 previous myocardial infarctions, for which he takes regular simvastatin, aspirin, ramipril and atenolol.

On examination, his right dorsalis pedis and tibialis anterior pulses are weak, and his right leg is pale and cold below the knee.

His pain is currently being managed with oramorph.

What should be included in the initial management plan for this likely diagnosis?

MSFinals-6442

A 75-year-old woman complains of mild lower back pain and tenderness around the L3 vertebra. Upon conducting tests, the following results were obtained: Hemoglobin levels of 80 g/L (120-160), ESR levels of 110 mm/hr (1-10), and an albumin/globulin ratio of 1:2 (2:1). What is the probable diagnosis?

MSFinals-6443

A 70-year-old man has presented to the falls clinic complaining of an increased frequency of falls over the past month. He has fallen 5 times in this period and now requires the assistance of a frame to move around. His wife reports that he experiences brief episodes of confusion followed by lucid periods. The patient’s medical history includes hypertension, alcoholic fatty liver disease, and gout.

During the examination, the patient displayed normal power and sensation in his upper limbs. He had a shuffling gait but generally good power in his lower limbs. The cranial nerve examination was unremarkable except for the inability to abduct his left eye on the left lateral gaze.

What is the most likely diagnosis?

MSFinals-6444

A 50-year-old man comes to see his GP complaining of right-sided groin pain and swelling in his scrotum, which has been going on for four days. He also reports experiencing dysuria. He denies any recent trauma and states that he has unprotected sexual intercourse with his wife, who uses hormonal contraception.

During the examination, the doctor notes that the patient’s right hemiscrotum is tender and erythematosus. However, the pain is alleviated when the testis is elevated. The patient’s vital signs are within normal limits, with a temperature of 37.1ºC, heart rate of 95 bpm, and blood pressure of 135/75 mmHg.

What is the most appropriate diagnostic step for this patient’s presentation?

MSFinals-6424

A 5-day-old neonate presents with sudden onset bilious vomiting. These episodes of vomiting are occurring frequently. On examination, he has a swollen, firm abdomen, is pale and appears dehydrated. He has not passed stool in the last 24 hours. He was born at term and there were no complications around the time of his delivery.
What is the probable diagnosis in this case?

MSFinals-6425

A 47-year-old woman is recuperating after a live donor related kidney transplant. She is experiencing considerable abdominal discomfort. What pain-relieving medication should she steer clear of?

MSFinals-6437

A 67-year-old man presents to the emergency department after a head injury. Four hours ago, he fell down the stairs and hit his head on the banister. He cannot recall what happened in the 30 minutes after the incident, but has no issues with memory of events leading up to the incident and no current memory problems. He denies any other symptoms. Upon examination, he responds and opens his eyes spontaneously, and is able to move all limbs normally. His pupils are equal and reactive to light, and there are no external signs of injury. What imaging study should be ordered?

MSFinals-6438

A 56-year-old plumber visits his family doctor complaining of a lump in his groin. He has a medical history of chronic obstructive pulmonary disease and no prior surgeries or medical issues. The lump has been present for three weeks, causes mild discomfort, and has not increased in size. During the physical examination, a soft, reducible lump is observed on the left side, located above the pubic tubercle, without skin changes. The doctor suspects an indirect inguinal hernia. What test would confirm this diagnosis?

MSFinals-6439

A 23-year-old male visits his GP complaining of natal cleft pain, along with purulent and bloody discharge from the area. He also has a fever. This is not the first time he has experienced these symptoms, as he has had similar episodes over the past three years. Typically, the symptoms resolve on their own, but return after a period of being asymptomatic. However, he underwent incision and drainage for his condition six months ago, and the symptoms have returned once again. What is the most effective treatment option for this individual?