Archives: Medical Student Finals

MSFinals-2631

A 67-year-old man presents to the emergency department after a fall. He is orientated to person, place and time with a GCS of 15. He tripped whilst walking around the house, falling onto his back. He denies any paraesthesia, weakness or pain radiating down his leg, as well as any bowel or bladder dysfunction. There is no evidence head trauma. He also denies any history of fever or weight loss. The patient has longstanding dyspepsia, for which he has been taking omeprazole for 4 years.

His observations are normal. On examination, there is marked spinal tenderness at the L2-L3 level. Neurological examination is unremarkable, with 5/5 power in both the upper and lower limbs.

What is the most appropriate, first-line investigation?

MSFinals-2632

Sarah, a 13-year-old girl presented with hip pain that worsened with walking and a snapping sensation when moving her hip. She has a history of recurrent left shoulder dislocations, but no past medical history of congenital hip dysplasia. Her father has Ehler-Danlos syndrome. On examination, there was no joint swelling and normal passive and active movement without restriction in the range of motion. What is a useful assessment for hypermobility?

MSFinals-2633

A 50-year-old woman presents to the Emergency Department with new back pain. She describes the pain radiating down the back of her right leg into her little toe and she has an associated weakness of her right leg which is stopping her from walking. She reports not having been able to pass urine all day despite feeling as though she needs to go.

On examination, she has a 4/5 weakness of the left leg throughout and a 3/5 weakness of the right leg throughout. Her reflexes are absent on her right and reduced on her left. She has a loss of pin prick sensation throughout the L4, L5, and S1 dermatomes on the right as well as in her perineum. On digital rectal examination, she has a loss of perianal sensation with normal anal tone but a reduced anal squeeze.

What investigation is most appropriate for this suspected diagnosis?

MSFinals-2634

A 50-year-old woman with chronic back pain arrives at the emergency department after experiencing a sudden exacerbation of her symptoms. She reports bilateral sciatica, left foot drop, perianal paraesthesia, and urinary incontinence over the past 24 hours. What imaging is necessary to confirm the suspected diagnosis?

MSFinals-2635

A 29-year-old man presents to his primary care physician with a gradual onset of lower back pain over the past six months. The pain is more severe in the morning and gradually improves throughout the day. He denies any history of trauma, weight loss, or bladder or bowel dysfunction. The patient has no significant medical history and occasionally takes ibuprofen, which provides some relief. He works as a teacher and has traveled extensively in South America over the past year.

During the physical examination, the patient exhibits tenderness in the lower back, but there are no neurological abnormalities. What is the most appropriate initial investigation to confirm the likely diagnosis?

MSFinals-2636

A 55-year-old woman visits her doctor complaining of fatigue and weakness. She has been experiencing difficulty getting up from chairs, lifting objects, and climbing stairs for the past 2 months. However, she has no issues with other movements like knitting or writing. Upon examination, she has bilateral hip and shoulder weakness. Blood tests reveal the following results: calcium 2.4 mmol/L (2.1-2.6), thyroid stimulating hormone (TSH) 4.5 mU/L (0.5-5.5), free thyroxine (T4) 12.4 pmol/L (9.0 – 18), creatine kinase (CK) 1752 U/L (35 – 250), and ESR 62 mm/hr (< 40). What is the most probable diagnosis?

MSFinals-2601

A 35-year old woman who is currently 20 weeks pregnant is concerned about the possibility of her child having congenital hip dislocation. She herself had the condition at birth, which went undiagnosed for 15 months and required corrective surgery. Despite the surgery, she has experienced hip pain throughout her adult life and is now scheduled for a hip replacement due to osteoarthritis. What is a known risk factor for congenital hip dislocation?

MSFinals-2602

An 80-year-old woman comes to the emergency department complaining of a headache that has persisted for the past week. She reports feeling pain on her left temple, which intensifies when she touches her head or brushes her hair, and discomfort in her jaw when eating. She is anxious because she recently had a brief episode of vision loss, which she describes as a dark curtain descending. What is the probable observation on fundoscopy?

MSFinals-2603

A 46-year-old man visits his doctor complaining of joint pain and stiffness in his fingers and wrists for the past 6 weeks. He is a pianist in a local orchestra and has noticed a decline in his performance due to his symptoms. On examination, there are visible deformities in his metacarpophalangeal joints with palpable tenderness, and his wrists are slightly swollen. He has a history of mild childhood asthma but has been otherwise healthy. There are no skin or nail changes. Based on the likely diagnosis, which of the following is associated with the poorest prognosis?

MSFinals-2604

A 65-year-old man presents to the GP with a 3-week history of generalised fatigue and weakness. He reports difficulty walking or standing for extended periods and struggles to get up from chairs. During examination, a violaceous non-oedematous rash is observed around his eyes, and his hands are extremely dry. Additionally, rough red papules are present over the extensor surfaces of his fingers. He has smoked 20 cigarettes a day for the last 45 years.
What is the most crucial next step in managing his likely diagnosis?