Archives: Medical Student Finals

MSFinals-2605

A 49-year-old man presents to the Emergency Department with right-sided flank pain radiating to the back which had developed over the past 10 days. There is no history of trauma or injury to the area.

He is a known intravenous drug user who has been commenced on a methadone rehabilitation programme around 2 weeks previously. He has no fixed abode and spends his night between various hostels.

He has no significant past medical history. Although has previous admissions following various injuries such as stabbings.

His observations are: heart rate 99/min, respiratory rate 16/min, blood pressure 98/75 mmHg, temperature 37.7º, Sats 99% on air.

On examination, he appears to be in pain and is lying flat on his back with his knees flexed. He is very tender over his back at L1 and L2 levels. He actively resists passive movement from his position of comfort and is unable to weight bear due to pain.

Blood tests show raised inflammatory markers, lumbar spine and pelvic x-ray show no abnormality.

He is requesting analgesia for his pain.

What is the most likely cause of this man’s symptoms?

MSFinals-2606

A 26-year-old man presents with a history of worsening low back pain over the past year. He reports that the pain is more severe after prolonged periods of sitting and experiences stiffness in the morning lasting up to 30 minutes. Despite being an active footballer and gym-goer, he has been troubled by pain in his right Achilles tendon, limiting his physical activity. The GP has referred him to a rheumatologist and ordered lumbar spine and sacroiliac joint x-rays. What collection of findings is most likely to be observed?

MSFinals-2607

A 5-year-old girl is brought to the emergency department with a suspected fractured femur. She has had multiple visits in the past few months. During the examination, her teeth are noted to be abnormal and she appears underweight. Additionally, her father expresses concern about her hearing.
What is the probable diagnosis?

MSFinals-2608

A 27-year-old soccer player arrives at the emergency department after sustaining a knee injury during a game. He reports feeling a ‘popping’ sensation in his right knee after landing awkwardly while attempting to kick the ball. The knee has since become swollen and he is unable to put weight on it. Upon examination, there is significant swelling and tenderness along the anterior joint line. What is the most reliable test for diagnosing this injury?

MSFinals-2609

A 50-year-old man presents to the emergency department with acute joint swelling. He has a history of type 2 diabetes and hypercholesterolemia and takes metformin and atorvastatin. He smokes 25 cigarettes daily and drinks 20 units of alcohol per week.

His left knee joint is erythematosus, warm, and tender. His temperature is 37.2ºC, his heart rate is 105 bpm, his respiratory rate is 18 /min, and his blood pressure is 140/80 mmHg. Joint aspiration shows needle-shaped negatively birefringent crystals.

What is the most appropriate investigation to confirm the likely diagnosis?

MSFinals-2610

A 42-year-old Vietnamese man comes to the emergency department complaining of left-sided flank pain that has been bothering him for the past 3 weeks. He denies experiencing any urinary symptoms and has already taken nitrofurantoin prescribed by his GP, but it did not alleviate his pain. During the physical examination, he has a fever of 38.4 °C, and his pain worsens when his left hip is extended. What is the probable diagnosis?

MSFinals-2611

A 35-year-old businesswoman comes to the GP complaining of persistent pain and swelling in her forefoot. She reports that she recently relocated to London for a new job and spends a lot of time on her feet, often wearing high heels. The pain is exacerbated when she bears weight on her foot, and squeezing the area reproduces the discomfort. Based on these symptoms, which bone is most likely affected by a stress fracture?

MSFinals-2612

A 35-year-old female patient reports a constant ‘funny-bone’ feeling in her left elbow, along with tingling in the pinky and ring fingers. The symptoms intensify when the elbow is flexed for extended periods. What is the probable diagnosis?

MSFinals-2613

A 45-year-old patient presents with an upper limb nerve injury. The patient reports weak finger abduction and adduction with reduced sensation over the ulnar border of the hand. Clawing of the 4th and 5th digits is observed during examination. The patient experiences worsening of this deformity during recovery before eventually resolving. What is the most probable diagnosis?

MSFinals-2614

A 57-year-old motorcyclist is involved in a road traffic accident and suffers a displaced femoral shaft fracture. No other injuries are found during the primary or secondary surveys. The fracture is treated with closed, antegrade intramedullary nailing. The next day, the patient becomes increasingly confused and agitated. Upon examination, he is pyrexial, hypoxic with SaO2 at 90% on 6 litres O2, tachycardic, and normotensive. A non-blanching petechial rash is observed over the torso during systemic examination. What is the most probable explanation for this?