Archives: Medical Student Finals

MSFinals-2475

A 35-year-old female accountant presents to her local urgent care centre with a 4 day history of right side thumb and wrist pain. She complains of pain down the dorsal aspect of her thumb towards the radial aspect of her wrist which occurs when she is at work and using her computer mouse for extended periods of time. She reports the pain is not present at rest.

During examination, you are able to reproduce the pain when she abducts her thumb against resistance. The patient also reports pain when you palpate over her radial styloid process. There is no other sensory or motor deficits in the remainder of your examination. There does not appear to be any erythema or swelling that you note.

What is the likely diagnosis based on these findings?

MSFinals-2476

A 32-year-old female patient complains of a painful wrist that has been bothering her for 6 weeks. During the examination, she experiences pain on the radial side of the wrist when the thumb is forcefully adducted and flexed. What is the probable diagnosis?

MSFinals-2477

A 25-year-old man presents to the emergency department with a crush injury to his forearm. Upon examination, the arm is found to be tender, swollen, and red. The patient reports significant pain in the affected area. Clinical evidence suggests an ulnar fracture, and the patient is unable to move their fingers and complains of numbness. What is the most suitable course of action?

MSFinals-2478

A 65-year-old woman with breast cancer and bony metastases has been admitted to your ward following a vertebral fracture sustained while twisting in her car seat. The orthopaedic team is managing this conservatively. She has a medical history of hypertension, type 2 diabetes, chronic kidney disease stage 4, and gastro-oesophageal reflux disease. Currently, she is taking amlodipine and omeprazole. She previously took alendronic acid but stopped due to severe reflux. What is the most appropriate treatment to initiate?

MSFinals-2479

A 28-year-old male was admitted to orthopaedics 3 days ago following a snowboarding accident. X-rays revealed a closed right tibial shaft fracture with minimal displacement. Over the past 4 hours, he has been experiencing severe pain in the leg, despite receiving hourly oral morphine in addition to regular paracetamol and ibuprofen. His urine has turned dark and a dipstick test shows the presence of blood.

On admission, his electrolyte and renal function tests were as follows:
Na+ 138 mmol/L
K+ 4.1 mmol/L
Bicarbonate 23 mmol/L
Urea 3.8 mmol/L
Creatinine 72 µmol/L

However, on day 3 of admission, his results have changed significantly:
Na+ 142 mmol/L (135 – 145)
K+ 5.6 mmol/L (3.5 – 5.0)
Bicarbonate 18 mmol/L (22 – 29)
Urea 11.9 mmol/L (2.0 – 7.0)
Creatinine 189 µmol/L (55 – 120)

What is the primary factor contributing to the development of acute kidney injury (AKI) in this patient?

MSFinals-2480

A 54-year-old woman presents with thickened skin on her face and below her elbows, while the skin above her elbows appears normal. She has a known history of Raynaud’s phenomenon. What is the probable diagnosis?

MSFinals-2481

A 45-year-old male with a medical history of ulcerative colitis and gout presents to the emergency department with a sore throat and coughing up green sputum for the past three days. He reports pain when breathing in and has never had a chest infection before. He is currently in remission for an acute flare of ulcerative colitis and is taking azathioprine. One month ago, he started a medication for his gout, but he cannot recall the name and did not bring it with him.

Upon examination, bibasal crepitations and increased vocal fremitus are noted at the bases of his chest. His throat is erythematosus with exudate around the tonsils. He has a fever of 38.9ºC, a heart rate of 97/min, and a respiratory rate of 24/min. Blood tests reveal low levels of white blood cells and a high CRP. A chest x-ray shows bibasal consolidation.

Based on his clinical presentation and medication history, you suspect that the medication started for his gout has interacted with his azathioprine, leading to agranulocytosis. What is the most likely medication that he started for his gout?

MSFinals-2482

A 75-year-old man with a history of osteoarthritis and high blood pressure visits his GP to discuss the results of recent tests. He follows a vegetarian diet and enjoys gardening. During the examination, the doctor notes deformities in the man’s fingers but otherwise finds nothing unusual. The man’s DEXA scan T-score was -2.5. The table below shows his blood test results.
Calcium 2.0 mmol/L (2.1-2.6)
Phosphate 1.2 mmol/L (0.8-1.4)
Magnesium 0.9 mmol/L (0.7-1.0)
Thyroid stimulating hormone (TSH) 2.5 mU/L (0.5-5.5)
Free thyroxine (T4) 14 pmol/L (9.0 – 18)
Amylase 250 U/L (70 – 300)
Uric acid 0.22 mmol/L (0.18 – 0.48)
Creatine kinase 150 U/L (35 – 250)

What is the first course of treatment that should be considered?

MSFinals-2483

As an FY2 in the ED, you assess a 32-year-old woman who has been experiencing right wrist pain for the past 6 weeks. The pain has been gradually increasing in intensity. She has no significant medical history, except for a previous visit to this ED 4 months ago. During that visit, she fell off her skateboard and landed awkwardly on the same wrist. However, the x-ray at the time was normal, and she was discharged home with safety netting advice and a repeat x-ray scheduled, although no image is available on the system. When asked about the follow-up, she mentions that she had no pain at the time and wanted to avoid an unnecessary trip to the hospital during the COVID-19 pandemic. What would be the most appropriate course of action?

MSFinals-2448

A 30-year-old woman with a history of rheumatoid arthritis visits her GP with the desire to conceive. She is worried about the medications she takes for her condition and recalls her rheumatologist mentioning the need to modify her treatment during pregnancy. She is currently on methotrexate and hydroxychloroquine. What guidance should be provided regarding her medication use during pregnancy?