Archives: Medical Student Finals

MSFinals-2504

A 25-year-old woman with a history of systemic lupus erythematosus (SLE) visits her GP complaining of myalgia and fatigue. She is worried that her SLE is flaring up and has a tendency to develop health anxiety due to her condition. As lupus can affect multiple organs and systems, she frequently visits her GP practice whenever she experiences new symptoms. The GP conducts some blood tests, which reveal the following results:
– Hb: 111 g/L (Male: 135-180, Female: 115-160)
– MCV: 86 fl (84-96)
– WBC: 12.3 * 109/L (4.0-11.0)
– Urea: 6.7 mmol/L (2.0-7.0)
– Creatinine: 118 µmol/L (55-120)
– eGFR: 90 ml/min/1.73m² (>/= 90)
– CRP: 88 mg/L (<5)
– ESR: 34 mm/hr (0-20)

What is the probable cause of the patient’s symptoms?

MSFinals-2505

A 65-year-old woman presents with a 4-week history of widespread pain, stiffness, and subjective weakness to her shoulders bilaterally. Getting dressed in the morning is taking longer, sometimes up to 45 minutes due to her symptoms. She denies any scalp tenderness or jaw claudication.

Upon examination, there is no objective weakness identified in her upper and lower limbs. No erythema or swelling is visible in her shoulders. Passive motion of her shoulders bilaterally improves her pain.

What is the most probable underlying diagnosis?

MSFinals-2506

A 78-year-old female complains of stiffness and pain in her pelvic and shoulder girdle, along with painful mastication. She consumes around 12 units of alcohol per week and takes atorvastatin and amlodipine. Her ESR is found to be 90mm/hour. What is the probable diagnosis?

MSFinals-2507

A 65-year-old man with rheumatoid arthritis is scheduled for a procedure at the day surgery unit. The surgery is aimed at treating carpal tunnel syndrome. During the procedure, which structure is divided to decompress the median nerve?

MSFinals-2484

A 25-year-old woman is seeking a referral to an obstetrician as she has been trying to conceive and her menstrual period is now one month late. She has tested positive on a home pregnancy test. She has a history of seropositive rheumatoid arthritis for the past two years and is currently only taking hydroxychloroquine as methotrexate was stopped six months ago in anticipation of conception.

During the physical examination, swelling is noted on the second and third metacarpophalangeal joints of her right hand. The pregnancy test is positive. What is the most appropriate treatment for her at this time?

MSFinals-2485

A 50-year-old woman arrives at the emergency department following a fall. According to her son, she stumbled over an exposed tree root and landed on her outstretched arms. Since the fall, she has been holding her right arm and complaining of intense pain.

An x-ray is ordered, revealing a fracture of the distal radius with posterior displacement. Additionally, the ulnar tip is also fractured. The fracture is located across the metaphysis of the radius and does not involve the articular cartilage.

What is the name of this type of fracture?

MSFinals-2486

A 60-year-old gardener comes to the clinic with rough red papules on his knuckles. The rash has been developing gradually over the past few weeks, and he is unsure of the cause. He reports that the rash is both itchy and painful. Additionally, he has been experiencing difficulty with heavy lifting and climbing stairs. What is the most likely explanation for this patient’s symptoms?

MSFinals-2487

A 25-year-old man presents to the emergency department with complaints of lower back pain that has been ongoing for the past week. The pain has gradually worsened over the last few days, and he is now unable to change his posture due to the severity of the pain. The patient has a history of intravenous drug use and had visited his GP earlier in the month for shortness of breath and a low-grade fever. On examination, the patient has a temperature of 40ºC, needle track marks on his forearm, a systolic murmur in the tricuspid region, and severe restriction of movement in his back. A urine dip test reveals the presence of blood, but no other abnormalities are found. An MRI of the spine confirms a diagnosis of discitis. What other urgent investigations should be performed?

MSFinals-2488

A 70-year-old woman presents with sudden vision loss in her left eye. She has been experiencing bilateral headaches, neck and shoulder stiffness, and pain for the past two weeks, which is most severe in the morning and improves throughout the day.

Upon examination, her strength and sensation are normal, but she has limited shoulder and neck range of motion due to discomfort. Her left eye vision is reduced to hand movements only. The patient has a medical history of hypercholesterolemia and myocardial infarction and is currently taking atorvastatin, aspirin, ramipril, and bisoprolol.

What is the most likely finding on fundoscopy?

MSFinals-2489

You are an F2 doctor in the Emergency Department and a 7-year-old child comes in with a 10-day history of fever, lethargy, and general malaise. The parents are concerned about a new pain in the left upper leg. After requesting an X-ray, it shows a localized osteolytic region indicating osteomyelitis. Which part of the bone is typically affected in children with this diagnosis?