Archives: Medical Student Finals

MSFinals-2490

Sarah is a 19-year-old woman who visits her GP complaining of myalgia and fatigue. She has no significant medical history. In the past, she had a rash on her cheeks that did not improve with anti-fungal cream.
During the examination, her vital signs are normal, and there is no joint swelling or redness. However, she experiences tenderness when her hands are squeezed. Sarah’s muscle strength is 5/5 in all groups.
Sarah’s maternal aunt has been diagnosed with systemic lupus erythematosus (SLE), and she is worried that she might have it too.
Which of the following blood tests, if negative, can be a useful test to rule out SLE?

MSFinals-2491

John is an 80-year-old man who has come in with stiffness and pain in both shoulders. His doctor suspects PMR and orders some blood tests.
ESR – erythrocyte sedimentation rate
CRP – C-reactive protein
Anti-ccp – anti-cyclic citrullinated peptide
CK – creatine kinase
Which of the following results would be most indicative of PMR in John?

MSFinals-2492

A 70-year-old woman presents with pain and stiffness in her shoulder and pelvic girdle. She reports feeling weak and struggling with her daily activities. The pain and stiffness are most severe in the morning and gradually improve throughout the day, lasting up to 5 hours after waking.

During the examination, there is no apparent weakness in any of her limbs, but there is stiffness and pain in her proximal muscles. She has a medical history of hypercholesterolemia and depression and is currently taking atorvastatin and sertraline. What investigation findings are expected, given the probable diagnosis?

MSFinals-2493

A 32-year-old businessman came to the hospital with a low-grade fever, blood-streaked sputum and a dry cough that had been persisting for 7 weeks. He had been travelling extensively in India, staying in cheap and unsanitary accommodations. Upon further testing, he was diagnosed with tuberculosis and started on appropriate antibiotics. However, when he visited your outpatient clinic two weeks later, he complained of joint pain, fatigue, and a new rash that was limited to his face and had a butterfly shape. You suspect that one of the drugs he is taking is causing drug-induced lupus. Which drug is responsible for his condition?

MSFinals-2494

A 23-year-old man comes to the clinic complaining of low back pain and stiffness that has persisted for over 3 months. He denies any history of injury. The patient reports that his symptoms are worse in the morning but improve with exercise. Routine blood tests were normal except for an ESR of 30 mm/hour (normal range: 0-15) and a CRP of 15 mg/L (normal range: <10). A plain x-ray of the sacroiliac joints reveals erosions, sclerosis, and joint space widening, leading to a diagnosis of ankylosing spondylitis. What is the next step in managing this patient's condition?

MSFinals-2495

Sophie is a 32-year-old cyclist who fell off her bike two days ago and landed on her outstretched hands. She did not hit her head. Today, she visited the emergency department complaining of pain in her right hand. She denies pain in other parts of her body.

Upon examination, her right hand is mildly swollen, but there is no visible deformity. She experiences tenderness when palpated around her wrist dorsally and is particularly sensitive in the anatomical snuffbox area. Although the range of active movement of her wrist is limited due to pain and swelling, she was able to demonstrate thumb and wrist extension.

After undergoing a standard x-ray series of her hand, wrist, and forearm, no fractures were detected. What is the most probable diagnosis?

MSFinals-2496

A 25-year-old female presents to the emergency department with tenderness over the lateral aspect of her midfoot after slipping off a kerb while walking. She is having difficulty walking and a radiograph reveals a fracture of the 5th metatarsal. What is the most probable mechanism of action that caused this fracture?

MSFinals-2497

A 28-year-old man has been admitted to the hospital for 6 hours after fracturing his right tibia while playing football. He has been managing his pain well until 30 minutes ago when he started experiencing intense pain in his right lower leg. Upon examination, he is in severe pain, which worsens with passive movement of the foot. However, you are able to palpate the dorsalis pedis and posterior tibial pulse on the right foot. His heart rate and respiratory rate are both elevated (110/min and 22/min respectively), and he is sweating profusely. What is the definitive management for this condition?

MSFinals-2498

A 33-year-old female who cannot tolerate methotrexate is initiated on azathioprine for her rheumatoid arthritis. During routine blood monitoring, the following results are obtained:
– Hemoglobin (Hb): 7.9 g/dl
– Platelets (Plt): 97 * 109/l
– White blood cells (WBC): 2.7 * 109/l

What are the factors that can increase the risk of azathioprine toxicity in this patient?

MSFinals-2499

A 61-year-old man arrives at the Emergency Department complaining of intense pain in his right ankle and 1st metatarsophalangeal joint. The pain started overnight and has worsened since he took his furosemide in the morning. He is also taking omeprazole for a recent peptic ulcer. What medication should be prescribed to alleviate his symptoms?