Archives: Medical Student Finals

MSFinals-2719

A 57-year-old woman visits her doctor complaining of fatigue and difficulty standing up from her chair for the past four weeks. She reports experiencing eyelid swelling and feeling generally unwell for the past two months, and now has trouble walking and grooming herself. Upon examination, the doctor observes reduced strength in her hips and shoulders, a heliotrope rash around her eyes, and a thick red rash on her knuckles. The doctor suspects a rheumatological condition and refers her for further testing. What urgent additional investigation is required, given the probable diagnosis?

MSFinals-2720

A 68-year-old male presents to his primary care physician complaining of back pain. He reports experiencing a sharp, burning pain in the middle of his back over the past few days. The pain is severe enough to wake him up at night and he has found little relief with paracetamol. He is requesting a stronger medication. He denies any leg weakness, urinary incontinence, or numbness.

The patient has no other medical conditions, but he recalls being informed of an irregular prostate during his last visit with his primary care physician six months ago. He received letters for further testing but did not attend the appointments.

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

MSFinals-2721

A 28-year-old woman comes in with complaints of intermittent pain in her left hand for several months, particularly when exposed to cold weather. She describes the pain as spasming and accompanied by numbness and a change in color in her hand. Upon examination, she appears to be in good health, and there are no visible signs or symptoms. However, a non-specific rash resembling eczema is present in the flexure creases. Blood tests are conducted, and the patient is referred for further specialized testing. What factors would suggest a primary disease rather than a secondary one?

MSFinals-2722

A 67-year-old man comes to the clinic complaining of sudden and severe pain in his right knee. He has never experienced this before. Upon examination, the joint fluid is extracted and sent to the lab for analysis. The rheumatology team suspects pseudogout. What characteristics can help differentiate this condition from gout?

MSFinals-2723

A 28-year-old female patient is referred to the orthopaedics department with a history of non-Hodgkin’s lymphoma three years ago. Despite regular follow-up scans showing no signs of disease recurrence, she has been experiencing worsening pain in her right hip for the past two months, particularly during exercise. During examination, she experiences pain in all directions when her hip is moved passively, with internal rotation being particularly painful. An x-ray ordered by her GP has come back as normal. What is the most probable diagnosis?

MSFinals-2724

A 54-year-old man visits his GP with complaints of muscle weakness and constipation for the past three weeks. He also reports feeling increasingly tired and thirsty during this time. The patient has a history of a previous STEMI and stage 1 chronic kidney disease. Upon examination, the GP orders some blood tests, which reveal the following results:

– Calcium: 3.1 mmol/L (2.1-2.6)
– Phosphate: 0.6 mmol/L (0.8-1.4)
– ALP: 174 u/L (30 – 100)
– Na+: 140 mmol/L (135 – 145)
– K+: 3.7 mmol/L (3.5 – 5.0)
– Bicarbonate: 25 mmol/L (22 – 29)
– Urea: 5.0 mmol/L (2.0 – 7.0)
– Creatinine: 70 µmol/L (55 – 120)

What is the most likely diagnosis?

MSFinals-2725

A 38-year-old woman comes to her GP with a few months of gradual symmetrical swelling and stiffness in her fingers. She experiences more discomfort in cold weather. Additionally, she reports having more frequent episodes of ‘heartburn’ lately. During the examination, the doctor observes three spider naevi on her face, and her fingers appear red, slightly swollen, and shiny. The examination of her heart and lungs reveals no abnormalities. What is the probable diagnosis?

MSFinals-2726

A 38-year-old teacher presents to your clinic with complaints of painful and stiff joints. The stiffness is more pronounced in the mornings and lasts for over an hour, but improves as the day progresses. The patient reports feeling fatigued but denies any other symptoms. Upon examination, synovitis is observed in two interphalangeal joints of the left hand, left wrist, and a single distal interphalangeal joint in the right foot. The patient is referred to a rheumatologist who diagnoses psoriatic arthritis. What is the most distinguishing feature between psoriatic arthritis and rheumatoid arthritis?

MSFinals-2727

A 50-year-old woman presents with swelling and pain in several joints of her right hand and left wrist. The affected joints are also stiff, erythematosus, and warm to touch. She denies any recent injury to the joints and is otherwise healthy. Upon joint aspirate, the sample appears turbid and yellow with a WBC count of 25,000/mm³ and 70% neutrophils. Viscosity is reduced and polarised light microscopy is unremarkable. What is the most probable diagnosis?

MSFinals-2728

A 55-year-old woman comes to her doctor complaining of persistent stiffness and pain in the distal interphalangeal (DIP) joints of her left hand. She reports that her symptoms are more severe in the morning and improve with activity.

What is the probable diagnosis?