Archives: Medical Student Finals

MSFinals-2407

John, a 35-year-old Caucasian man visited his doctor with a range of symptoms. He reported feeling feverish on and off for the past few months, experiencing fatigue, unintentional weight loss of around 3kg, and general muscle aches and pains. He was not taking any medication. Upon examination, his doctor found no abnormalities in his observations or physical examination. The doctor ordered a full blood count, which showed the following results:

– Hb 112g/L Male: (130 – 180)
– Platelets 200 * 109/L (150 – 400)
– WBC 3.8 * 109/L (4.0 – 11.0)
– Lymphocytes 2.8 * 109/L (1.0 – 4.5)
– Mean corpuscular volume 92 fL (76 – 98)
– Mean corpuscular haemoglobin 31 pg (27 – 32)
– Ferritin 40 ng/mL (20 – 230)

Based on these results, the doctor suspects that John may have systemic lupus erythematosus (SLE) and orders further blood tests. Which test, if positive, would best indicate that John is likely to have this condition?

MSFinals-2408

A 35-year-old male patient presents to his primary care physician with complaints of progressive weakness and pain in his arms and hands, along with increasing fatigue, particularly during physical activity. During the examination, the physician detects faint fine crackles in the lower-mid zones and observes thickened and cracked skin on the patient’s hands. The patient also experiences difficulty transitioning from the chair to the examination couch. What is the primary blood marker associated with this condition?

MSFinals-2409

A 55-year-old female complains of dry eyes, dry mouth, arthralgia and fatigue for the past 4 months. During examination, there is conjunctival injection, reduced salivary pool, dry mucous membranes and oral ulceration. The Schirmer’s test is positive. Which of the following tests is the most suitable?

MSFinals-2410

Sophie is a 26-year-old woman who has come to you with a rash on her cheeks and bridge of her nose. She has also been experiencing non-specific muscle and joint aches and extreme fatigue. You want to run some blood tests to check for any systemic causes, specifically for systemic lupus erythematosus (SLE). Which of the following positive blood tests would strongly indicate a diagnosis of SLE?

Out of the options below, which of the following blood tests if positive would be highly suggestive of this diagnosis?

MSFinals-2399

What factors are linked to a favorable outcome in rheumatoid arthritis prognosis, particularly in younger patients?

MSFinals-2400

A 54-year-old woman presents to the rheumatology clinic with a history of her fingers turning white, blue, and red intermittently for the past four months. She also reports tightness of the skin on her fingers, hands, and face, without involvement of the skin on her upper arm or chest. Additionally, she experiences troubling reflux symptoms. On examination, there is fibrotic skin overlying the hands and face with telangiectasia. Which autoantibody is most likely to be positive in this patient, given the probable diagnosis?

MSFinals-2380

A 50-year-old man presents to the hospital with acute knee pain, swelling, and stiffness that started last night. He is experiencing systemic symptoms with a temperature of 39.2ºC and is unable to bear weight. A joint aspiration is performed to confirm the diagnosis.
What is the recommended duration of antibiotic treatment for this patient’s most likely diagnosis?

MSFinals-2381

A 35-year-old man has been diagnosed with ankylosing spondylitis and his condition is not well controlled. His rheumatologist suggests starting him on a new medication. In cases of predominantly axial disease, how many non-steroidal anti-inflammatory drugs must be ineffective before anti-TNF alpha inhibitors can be considered?

MSFinals-2382

A 35-year-old woman presents to the emergency department with an acutely swollen and red left leg, which she reports first noticing around 12-hours ago. She denies any medical conditions, medications, or family history of similar events. A negative pregnancy test rules out pregnancy. Upon examination and doppler ultrasound scan, she is diagnosed with a deep vein thrombosis (DVT). Routine blood tests reveal thrombocytopenia and a prolonged activated partial thromboplastin time (APTT), leading to an antibody screen and a subsequent diagnosis of antiphospholipid syndrome. What is the most appropriate long-term anticoagulation strategy for this patient?

MSFinals-2383

A 45-year-old female presents to the emergency department following a fall during a walk. She reports experiencing discomfort in her right shoulder. During the examination, the right arm is externally rotated and abducted, and she resists all movements. The acromion is noticeable, and the X-ray shows the humeral head in a subcoracoid position in the anteroposterior view. What proportion of shoulder dislocations exhibit the same characteristics as this patient?