Archives: Medical Student Finals

MSFinals-2434

A twenty-seven-year-old male presents to the emergency department with an ache-like pain in his back that radiates to his right groin. The pain started three days ago, has been progressively worsening, and is exacerbated by walking. He has attempted to alleviate the pain with paracetamol and ibuprofen, but to no avail. He also reports feeling feverish and experiencing chills for the past 24 hours.

The patient has no significant medical history but is a heavy smoker, consuming 20 cigarettes a day, drinks 30 units of alcohol per week, and injects heroin daily. Upon examination, his heart rate is 96/minute, respiratory rate is 14/minute, blood pressure is 116/72 mmHg, and oxygen saturations are 98%. His temperature is 38.4 ºC.

During examination of the spine and right hip, he experiences pain on movement of the hip joint, particularly flexion, but is not tender on palpation of the spine or hip joint. There is no evidence of swelling or erythema of the spine or hips, and no difference in temperature. Abdominal examination reveals a soft and non-tender abdomen, without organomegaly and present bowel sounds. The kidneys are non-ballotable.

What is the most likely diagnosis?

MSFinals-2435

An 80-year-old man is brought to the emergency department after falling on his left hip. Upon examination, he is experiencing difficulty walking, tenderness around his left greater trochanter, and his left leg is externally rotated and shortened. He has a medical history of osteoporosis, hypertension, and hypothyroidism. However, he is able to move around without any assistance. An X-ray reveals a subtrochanteric femoral fracture, which is treated with an intramedullary nail. What advice should he be given regarding weight-bearing?

MSFinals-2436

A 34-year-old male presents to his primary care physician for a sexual health screening. He complains of a painful and red sore that appeared on the shaft of his penis a few days ago. He reports that his wife, his only regular sexual partner, has not experienced any symptoms. Upon further questioning, he mentions feeling tired and run down after a stressful situation at work, which led to the development of painful mouth ulcers on his gums and lip. He has no significant medical history except for a few instances of painful and gunky eyes that he treated at home. On examination, the physician observes two small, healing ulcers in the patient’s mouth and an oval sore with an erythematosus border. The patient also has a 0.5 cm lesion on his penile shaft that appears erythematosus but has no discharge. What is the most probable diagnosis for this patient?

MSFinals-2437

A 57-year-old woman received a call from an out of hours GP who advised her to go to the emergency department due to abnormalities found on her blood tests during her annual well woman check-up. She has a medical history of systemic sclerosis and uses topical emollients on her hands. She denies any allergies, is an ex-smoker, and does not consume alcohol. Her blood results are as follows:

– Hb 110 g/L (115 – 160)
– Platelets 151 * 109/L (150 – 400)
– WBC 4.5 * 109/L (4.0 – 11.0)
– Na+ 137 mmol/L (135 – 145)
– K+ 4.2 mmol/L (3.5 – 5.0)
– Urea 11.5 mmol/L (2.0 – 7.0)
– Creatinine 164 µmol/L (55 – 120)
– eGFR 30 ml/min (>90)

Upon observation, the nurse notes that the patient’s blood pressure is high. In the right arm, it is 187/95 mmHg and in the left arm is 191/94 mmHg. What is the most appropriate treatment to initiate for this patient?

MSFinals-2438

A 50-year-old man with a history of haemochromatosis complains of a painful and swollen right knee. An x-ray reveals no fracture but significant chondrocalcinosis. Assuming the diagnosis is pseudogout, what is the most probable finding in the joint fluid?

MSFinals-2439

What type of complement deficiency is linked to the onset of systemic lupus erythematosus?

MSFinals-2440

You review the results of a DEXA scan for a 70-year-old man who was referred due to a family history of femoral fracture. His past medical history includes type 2 diabetes, for which he takes metformin. He is a former smoker, quit 10 years ago, drinks 5 units of alcohol per week and follows a vegetarian diet. His T-score is -2.5. Blood results are shown below.

Hb 140g/L 120-160g/L

WCC 7.0×109/l 4.0-11×109/l

Na+ 138 mmol/L 135-145 mmol/L

K+ 4.2mmol/L 3.5-5.0mmol/L

Ca2+ 2.3mmol/L 2.2-2.6mmol/L (adjusted)

Vitamin D 60 nmol/L >50 nmol/L

What is the most appropriate action?

MSFinals-2441

A 26-year-old woman comes to the clinic complaining of swelling in the joints of her hands for the past 4 months. She reports stiffness in the morning that lasts for an hour before improving throughout the day. There is no pain or swelling in any other part of her body. Upon examination, there is tenderness and swelling in the 1st, 2nd, and 3rd metacarpophalangeal joints of both hands. An x-ray of her hands and feet is taken, and she is given a dose of intramuscular methylprednisolone and started on methotrexate.

What is the most crucial additional treatment she should be offered?

MSFinals-2442

A 32-year-old male presents with a football-related injury. He complains of acute pain in his right calf that began with a popping sound during running. You suspect an Achilles tendon rupture and proceed to perform Simmonds’ Triad examination. What does this assessment entail?

MSFinals-2443

A 33-year-old male arrives at the emergency department following a car accident. He reports experiencing intense pain in his right ankle and is unable to put any weight on it. Upon examination, tenderness is noted over the distal tibia and there is an absence of the dorsalis pedis pulse on the right side. No neurological symptoms are observed. An X-ray confirms the presence of a displaced fracture in the ankle. What is the most appropriate initial course of action?