Archives: Medical Student Finals

MSFinals-2677

A 49-year-old woman presents with a 5-month history of joint pain in her left hand and a ‘sausage-like finger’. She reports her only medication is prescription coal tar shampoo.

She is tender over the left distal interphalangeal joints with mildly swollen fingers. Her left index finger is diffusely swollen.

Observations show a heart rate of 82 bpm, blood pressure of 130/90 mmHg, a temperature of 36.8ºC, and 98% oxygen saturation on room air.

She has an x-ray of her hand performed.

What would be the most likely findings on imaging?

MSFinals-2678

A 70-year-old woman visits her doctor complaining of chronic pain and morning stiffness in her hands that lasts for a few minutes. These symptoms have been gradually worsening over the past ten years. She applies diclofenac gel to her hands, which provides relief from the pain. During the examination, the doctor observes squaring of her thumbs on both sides.
What is the probable diagnosis based on the given presentation?

MSFinals-2679

A 72-year-old man presents to the emergency department after a fall resulting in a fracture of his distal 1/3 right femur. The radiologist noted v-shaped osteolytic lesions on his femur. Due to his age and the stability of the fracture, conservative management is chosen. His blood test results are as follows: haemoglobin 142 g/L (135-180), calcium 2.6 mmol/L (2.2 – 2.6), phosphate 0.9 mmol/L (0.74 – 1.4), alkaline phosphatase 418 u/L (30 – 100), and parathyroid hormone 52 pg/mL (10-55). The patient has a medical history of chronic kidney disease and diabetes. What is the most likely diagnosis?

MSFinals-2680

A 55-year-old woman is brought to the GP by her worried daughter. The patient has a history of mental health issues which limits her mobility, but she is still able to perform daily activities independently. Recently, the patient has been complaining of increased bone and joint pain, particularly in her legs and spine, accompanied by a general feeling of weakness. Upon examination, the patient exhibits tenderness in her long bones, weakness in her proximal muscles, and difficulty walking with a waddling gait. What is the most probable diagnosis based on the patient’s symptoms?

MSFinals-2681

A 72-year-old woman presents to the clinic with a history of widespread bone pain and weakness in her lower limbs for the past year. During the examination, you observe grade 4 weakness in her proximal lower limb muscles. The following blood results were obtained: calcium levels of 2.05 mmol/L (normal range: 2.1-2.6), phosphate levels of 0.6 mmol/L (normal range: 0.8-1.4), PTH levels of 21.2 pmol/L (normal range: 1.6-6.9), and ALP levels of 260 u/L (normal range: 30-100). What is the most probable diagnosis?

MSFinals-2682

A 70-year-old woman visits her GP with complaints of widespread bone pain and increased difficulty in performing daily activities, such as climbing stairs, due to muscle weakness. The patient reports that her symptoms worsen at night or after exertion. She also mentions experiencing sleep difficulties and fatigue. During the examination, the GP notes tenderness over the spine and muscle weakness in the arms and legs. The patient has been avoiding leaving her house due to the pandemic. What is the probable diagnosis?

MSFinals-2683

A sixty-eight-year-old male arrived at the emergency department after tripping while getting out of his car and falling on his left side. He is experiencing pain in his groin and is unable to put weight on his left side. During the examination, it was observed that his left leg is externally rotated and shortened. What classification system should be utilized to categorize this patient’s injury, given the most probable diagnosis?

MSFinals-2684

An 80-year-old man comes to the clinic complaining of hearing loss in one ear that has persisted for the last 3 months. Upon examination, Weber’s test indicates localization to the opposite side, and a CT scan of his head reveals a thickened calvarium with areas of sclerosis and radiolucency. His blood work shows an increased alkaline phosphatase level, normal serum calcium, and normal PTH levels. What is the most probable underlying diagnosis?

MSFinals-2685

A 7-year-old boy trips during recess and arrives at the Emergency Department with a severely painful left arm. X-rays reveal a distal humerus supracondylar fracture that is displaced posteriorly and closed. What signs would suggest an immediate requirement for surgery?

MSFinals-2686

A 28-year-old woman contacts her GP via telephone to discuss her back pain that has been ongoing for three months. She reports that the pain is most severe in the morning and is accompanied by stiffness, which gradually improves throughout the day with physical activity. The pain is primarily located in her lumbar spine, and she has been struggling to complete her daily tasks. Despite not having examined the patient, the GP suspects an inflammatory cause, specifically ankylosing spondylitis. What aspect of this history would raise the GP’s suspicion the most?