Archives: Medical Student Finals

MSFinals-2568

A 54-year-old woman presents to her GP complaining of fatigue and difficulty sleeping. She also experiences weakness in her limbs, making it hard to complete household tasks. She has a history of bipolar disorder, which has been well-controlled with lithium carbonate for many years. The following blood tests were taken:

– Hb: 113 g/L (normal range: 115 – 160)
– Platelets: 201 * 109/L (normal range: 150 – 400)
– WBC: 10.2 * 109/L (normal range: 4.0 – 11.0)
– Calcium: 2.81 mmol/L (normal range: 2.1-2.6)
– Phosphate: 0.55 mmol/L (normal range: 0.8-1.4)
– Parathyroid hormone: 17.1 pmol/L (normal range: 2.0-8.5)
– ALP: 207 u/L (normal range: 30 – 100)
– Serum lithium: 0.67 mmol/L (normal range: 0.4 – 1.0)

What is the most appropriate definitive management for this patient, given the likely diagnosis?

MSFinals-2569

A 70-year-old woman presents with sudden vision loss. She has been experiencing headaches, neck, and shoulder stiffness for the past 4 weeks, which is most severe in the morning and improves throughout the day. Her strength and sensation are normal, but she has limited range of motion in her neck and shoulders due to discomfort. The right eye is completely affected in terms of visual field, and optic disc pallor is observed during fundoscopy. The patient has a history of hypercholesterolemia and is a smoker, consuming 20 cigarettes per day. What is the most probable underlying cause for her condition?

MSFinals-2570

A 56-year-old man with a long-standing history of type 2 diabetes mellitus and stage 3 chronic kidney disease presents with complaints of back pain that has been gradually worsening over the past few weeks. His GP has referred him for further evaluation. Upon examination, the patient is lying on his left side with his hips slightly flexed. Attempting to palpate his abdomen causes pain in his left hip and back. The patient experiences increased pain when asked to flex his hip against resistance or hyperextend his hip. His vital signs are as follows: temperature 38.3 ºC, heart rate 95/min, respiratory rate 20/min, and blood pressure 140/82 mmHg. His abdomen is soft and non-tender. What is the most appropriate initial management for this patient’s condition?

MSFinals-2571

A 54-year-old woman arrives at the emergency department complaining of headaches and oliguria. Upon examination, she displays swollen, tight fingers and rough, thickened patches of skin on her neck and arms, as well as telangiectasia on her face. She also has bilateral lower limb pitting edema to the mid-tibia and is experiencing confusion. At triage, her blood pressure is measured at 223/125 mmHg. Her blood work reveals elevated levels of creatinine and urea compared to her results from one year ago. What treatment option is most likely to decrease the likelihood of her experiencing another renal crisis in the future?

MSFinals-2572

A 79-year-old male with a history of dementia arrived at the emergency department with a suspected hip fracture. After an x-ray, it was determined that he had a subcapital fracture of the femur with partial displacement. What would be the probable surgical treatment for this type of fracture?

MSFinals-2573

A 25-year-old man arrives at the emergency department following a cycling accident where he fell a few hours ago. He is holding onto his right shoulder and appears to be in significant pain. The patient denies experiencing any fever or other systemic symptoms, and there is no visible redness around the joint. An anteroposterior x-ray is performed, revealing that the humeral head has become dislodged from the glenoid cavity of the scapula anteriorly. What is the most suitable initial treatment for this probable diagnosis?

MSFinals-2574

A 42-year-old man visits his GP complaining of leg and back pain that has been bothering him for 6 weeks. The pain is exacerbated by sitting. During the examination, the GP observes weakness in left hip abduction and left foot drop. However, power in the right limb is normal, and lower limb reflexes are normal in both legs. The GP suspects a prolapsed disc. Which nerve root is most likely to have been affected?

MSFinals-2575

A 49-year-old man presents with recurrent back pain. He has a history of disc prolapse due to his previous manual labor job. The patient reports that he experienced sudden lower back pain while bending over to pick something up. Upon examination, he exhibits reduced sensation on the posterolateral aspect of his left leg and lateral foot. The straight leg raise test causes pain in his thigh, buttock, and calf region, and he displays weakness on plantar flexion with decreased ankle reflexes. What is the root compression that this patient has experienced?

MSFinals-2576

A 67-year-old woman visits her doctor with complaints of sudden onset of paraesthesia and pain in her right leg. Upon further inquiry, she describes the pain spreading along the back of her thigh and the posterolateral region of her leg, reaching the top of her foot and her big toe. During the examination, you notice a loss of sensation in the top of her right foot and weakened strength when attempting to dorsiflex her right ankle. Her reflexes are intact, and she has a positive right-sided straight leg raise test. What is the most probable cause of her symptoms?

MSFinals-2577

A 46-year-old man visits his GP complaining of back pain that extends to his right leg. He has no medical history and is not on any medications. During the examination, the doctor observes sensory loss on the posterolateral part of the right leg and the lateral aspect of the foot. The patient also exhibits weakness in plantar flexion and a decreased ankle reflex. Which nerve root is the most probable cause of these symptoms?