Archives: Medical Student Finals

MSFinals-2511

Liam is a 50-year-old man who visits his GP complaining of fatigue and low mood. Upon further inquiry, he reveals experiencing muscle stiffness, particularly in his shoulders, which can last up to an hour upon waking. During examination, there is no apparent joint swelling, and power is 5/5 in all muscle groups. However, movement is painful during shoulder abduction and elevation. Despite the pain, there is good range of movement, and there are no other neurological symptoms. Liam has a medical history of type 2 diabetes, for which he takes metformin. What is the most probable diagnosis?

MSFinals-2512

A 50-year-old woman comes to the rheumatology clinic with poorly controlled rheumatoid arthritis. Her hands and feet have been swollen and painful for the past five years, particularly her metacarpophalangeal joints. The stiffness and pain are worse in the morning but improve with use throughout the day. Despite trying methotrexate and sulfasalazine, both treatments have been unsuccessful. The doctor decides to start her on a trial of TNF-inhibitors. What should be done before beginning treatment?

MSFinals-2513

A 82-year-old man experiences a mechanical fall resulting in a pertrochanteric hip fracture. The fracture is treated with a dynamic hip screw (DHS). The physiotherapist on the ward asks for clarification on the patient’s weight bearing status.

What guidance would you provide?

MSFinals-2514

A 75-year-old male presents to his GP after receiving the results of his recent blood tests. He had initially complained of aches and pains a week ago, specifically in his shoulders and hips, which had been progressively worsening over the past 3 months. Upon examination, bilateral pain is noted in both the shoulders and hips, which is exacerbated by movement. No signs of muscular atrophy or weakness are observed. What would be the primary investigation recommended for the suspected diagnosis?

MSFinals-2515

A 75-year-old woman is referred to the rheumatology clinic by her general practitioner due to a macular rash on her back and shoulders, as well as red papules on the extensor surfaces of her fingers. Upon examination, these symptoms persist, and she reports experiencing weakness and pain in both shoulders, as well as difficulty swallowing. The patient has no significant medical history but is a smoker. What additional investigations are required for this patient’s most probable diagnosis?

MSFinals-2516

A 47-year-old woman comes to the rheumatology clinic for evaluation of her newly diagnosed rheumatoid arthritis. The clinician employs a scoring system to assist in the patient’s treatment plan.

What is the probable scoring system utilized?

MSFinals-2517

A 20-year-old male is admitted to the emergency department following a rugby game collision that resulted in an awkward landing on his arm. He cannot recall the exact details of the fall due to its suddenness. An x-ray is conducted, revealing a transverse fracture of the radius 1.5 cm proximal to the radiocarpal joint, with posterior displacement of the distal fragment. No significant signs are observed during examination of the elbow joint. What is the type of fracture sustained by this patient?

MSFinals-2518

A 14-year-old boy comes to his doctor with a lump on the back of his right arm that has been getting bigger for the past three months. Recently, the lump has become very painful. The doctor orders a shoulder X-ray, which shows a lytic lesion in the diaphysis of the right humerus with an ‘onion skin’ appearance. What is the probable diagnosis?

MSFinals-2519

A 45-year-old mechanic presents with joint pains. He has been experiencing intermittent pain, stiffness, and swelling in his hands and feet for the past few months. Although the stiffness tends to improve during the day, the pain tends to worsen. He has also noticed stiffness in his back but cannot recall any injury that may have caused it. During an acute attack, blood tests were taken and the results are as follows: negative rheumatoid factor, positive anti-cyclic citrullinated peptide antibody, uric acid level of 0.3 mmol/l (normal range: 0.18 – 0.48), and an ESR of 41 mm/hr. What is the most likely diagnosis?

MSFinals-2520

A 20-year-old male comes to you with a painful and swollen knee that has been bothering him for a week. He experiences stiffness in the morning. He has been experiencing pain while urinating for three weeks and has noticed red and painful eyes this morning. He has well-controlled asthma and no other medical conditions. He admits to having unprotected sexual intercourse four weeks ago and has not been tested for a sexually transmitted infection. What is the probable diagnosis?