Archives: Medical Student Finals

MSFinals-2729

A 56-year-old woman visits her GP complaining of fatigue and a painful finger that has been bothering her for the past 3 weeks. She has also discovered a soft lump at the base of her left calf and requests that it be examined. She denies any fever, weight loss, or trauma, and has a medical history of systemic lupus erythematosus.

During the examination, the GP observes erythema and swelling in the proximal interphalangeal joint of the left index finger. The patient can move the joint independently, but pain limits her range of motion. Arthrocentesis reveals yellow fluid without crystal formation or gram stain, but a high level of leukocytes (40,000/μL) and a predominance of polymorphonuclear neutrophils in the cytology.

What is the probable diagnosis?

MSFinals-2730

A 63-year-old woman comes to her doctor complaining of pain and swelling in the small joints of her hands that have been present for about eight weeks. She has no significant medical history and is not taking any regular medications. Upon examination, the doctor finds that the 2nd and 3rd proximal interphalangeal joints on both hands are swollen and tender. The doctor orders a plain radiography of the hands, which shows juxta-articular osteopenia. What is the most probable diagnosis?

MSFinals-2731

A 65-year-old woman visits her GP complaining of hand pains that have been bothering her for several years. She reports that the pains started in both wrists a few years ago and have since spread to several joints in her fingers. The pain tends to worsen after use and improves with rest. Although the affected joints feel stiff upon waking, this only lasts for a few minutes. The patient reports that she can still complete tasks without any difficulty.

During the examination, the patient experiences tenderness in the carpometacarpal joints and several distal interphalangeal joints (DIPs) on both sides. There are also painless nodes that can be felt over several DIPs. Based on these findings, what is the most likely diagnosis?

MSFinals-2732

A 72-year-old man visits his GP with complaints of hand pain. He reports difficulty with tasks such as buttoning his clothes, which has been ongoing for a few months. The patient notes stiffness in his fingers, particularly in the morning, and swelling, which is more pronounced in his left hand. Upon examination, the doctor observes swelling at the distal interphalangeal joints and limited range of motion, but no other abnormalities. The patient’s vital signs are within normal limits. He has a medical history of hypertension, type 2 diabetes, gout, and alcohol abuse. What is the most probable diagnosis?

MSFinals-2733

A 79-year-old man presents to the emergency department with sudden onset knee pain. He reports no other symptoms. The following observations and investigations were recorded:
– Respiratory rate: 18/min
– Oxygen saturations: 99% on air
– Heart rate: 72/min
– Blood pressure: 140/71 mmHg
– Temperature: 36.6ºC
– Hb: 144 g/L (135-180)
– Platelets: 390 * 109/L (150 – 400)
– WBC: 16.4 * 109/L (4.0 – 11.0)
– CRP: 42 mg/L (< 5)
– X-ray right knee: Normal joint space. Prominent calcification of the menisci and articular cartilage
– Synovial fluid microscopy and culture: White blood cells – 1700/mm³. No growth at 48 hours

What is the most likely diagnosis?

MSFinals-2734

A 31-year-old female intravenous drug user (IVDU) comes to the emergency department requesting pain relief for her back pain. You recognize her as a frequent visitor, having recently been treated for a groin abscess.

During the examination, her heart rate is 124/min, temperature is 38.1ºC, respiratory rate is 22/min, and she is alert. The patient is lying on her right side with her knees slightly bent, and tenderness is found over L3-L4.

Based on the examination findings, what is the most likely organism responsible for this case?

MSFinals-2735

A 26-year-old man visits his GP with complaints of joint stiffness that has been bothering him for the past month. The stiffness is at its worst in the early morning and improves with use. He has no medical history, but his family has a history of psoriasis and vitiligo. The patient smokes about ten cigarettes per day and recently recovered from a viral throat infection two days ago.

During the examination, the doctor notices swelling in the patient’s left knee and 1st and 2nd metatarsophalangeal joints of his right foot. The swelling is accompanied by tenderness and reduced range of active and passive movement. What is the most probable diagnosis?

MSFinals-2701

A 28-year-old amateur football player arrives at the emergency department complaining of knee pain. During the game, she experienced a popping sensation in her left knee. Upon examination, her knee is swollen, and she cannot fully extend it. Which diagnostic test is most likely to reveal the underlying cause?

MSFinals-2702

A 60-year-old man comes to the emergency department complaining of a painful hand after falling on an outstretched hand. Upon examination, there is tenderness in the anatomical snuffbox, but the hand is neurovascularly intact. Scaphoid view x-rays of the hand show a fracture of the proximal pole of the scaphoid. What is the best course of action for managing this situation?

MSFinals-2703

A 55-year-old man visits his GP with complaints of numbness and tingling in both hands. He experiences these symptoms more severely at night and has to shake his hands for relief. He is worried that his job, which involves a lot of typing, will be affected by his symptoms. Additionally, he is concerned that his hobby of playing tennis will also be impacted. The patient has a medical history of rheumatoid arthritis and takes methotrexate. On examination, Tinel’s test is positive bilaterally, and his BMI is 18kg/m². What is the most significant risk factor in this patient’s medical history for this condition?