Archives: Medical Student Finals

MSFinals-2322

A 14-year-old girl presents with a 3-day history of fever and polyarthralgia. She has widespread aches in multiple joints, including the hips, wrists and knees. She is normally fit and well, and the only medical history to note was eczema as a child, which she has now grown out of. The patient’s mother mentions that she did have a sore throat around two weeks ago, which was self-limiting. From the history and examination findings, the examining doctor feels that the patient is likely to have rheumatic fever.
Which of the following is most likely to be the cause of rheumatic fever?

MSFinals-2301

A 65-year-old male who recently had cardiac surgery is experiencing symptoms of fever, fatigue, and weight loss. After being discharged following a successful mitral valve replacement 6 months ago, an urgent echocardiogram is conducted and reveals a new valvular lesion, leading to a diagnosis of endocarditis. To confirm the diagnosis, three sets of blood cultures are collected. What is the most probable organism responsible for the patient’s condition?

MSFinals-2302

A 76-year-old male who is currently receiving end of life care and is on opioids for pain management requests some pain relief for breakthrough pain. He has a medical history of metastatic lung cancer, hypertension, type 2 diabetes mellitus, and chronic kidney disease. Earlier in the day, his latest blood results were as follows:

Hb 121 g/L Male: (135-180)
Female: (115 – 160)

Platelets 340 * 109/L (150 – 400)

WBC 9.7 * 109/L (4.0 – 11.0)

Na+ 142 mmol/L (135 – 145)

K+ 4.9 mmol/L (3.5 – 5.0)

Urea 25.7 mmol/L (2.0 – 7.0)

Creatinine 624 µmol/L (55 – 120)

eGFR 9 mL/min/1.73m² (>90)

CRP 19 mg/L (< 5) What is the most appropriate pain relief for this situation?

MSFinals-2303

John is a 44-year-old man who presented to you a month ago with a 6-week history of upper abdominal pain, heartburn, and occasional reflux. His medical history is unremarkable, and you both agreed on a plan for a 1-month trial of omeprazole 20 mg daily.

John returns for a follow-up appointment after completing the course of omeprazole. Unfortunately, his symptoms have only slightly improved and are still causing him distress.

What would be the most suitable course of action to manage John’s persistent symptoms?

MSFinals-2300

A 51-year-old woman visits her GP with complaints of diffuse abdominal pain and a single episode of haematuria. During the physical examination, the GP notes that both kidneys are enlarged and the patient experiences some discomfort. The patient is worried as her father had kidney problems around the same age. An abdominal ultrasound is ordered by the GP. What is the potential complication that this patient is most likely to be at risk of, considering the probable diagnosis?

MSFinals-2286

A 55-year-old man with a history of hypertension has a 10-year cardiovascular disease risk of 20%. Atorvastatin 20 mg is prescribed, and liver function tests are conducted before starting treatment:

Bilirubin 10 µmol/l (3 – 17 µmol/l)
ALP 96 u/l (30 – 150 u/l)
ALT 40 u/l (10 – 45 u/l)
Gamma-GT 28 u/l (10 – 40 u/l)

After three months, the LFTs are repeated:

Bilirubin 12 µmol/l (3 – 17 µmol/l)
ALP 107 u/l (30 – 150 u/l)
ALT 104 u/l (10 – 45 u/l)
Gamma-GT 76 u/l (10 – 40 u/l)

What is the best course of action to take?

MSFinals-2287

A 68-year-old man is 2 days post-op for a laparoscopic prostatectomy and experiences difficulty breathing. He has been unable to move around since his surgery and is experiencing poorly managed pain. He has no significant medical history.
During the examination, he is lying flat in bed and his oxygen saturation is at 95% on room air. His calves are soft and non-tender. A chest X-ray reveals basal atelectasis.
What immediate measures should be taken to improve his breathing?

MSFinals-2288

A 56-year-old man presents to the emergency department with dyspnea. A chest x-ray is performed, and pleural fluid is aspirated for analysis. The pleural fluid results reveal:
– Fluid Protein 58 g/L (normal range: 10-20g/L)
– Fluid LDH 1048 IU/L (less than 50% of plasma concentration)
– Fluid Glucose 1.2 mmol/L (normal range: 4-11 mmol/L)
– Fluid pH 7.23 (normal range: 7.60-7.64)
– Cell Cytology shows normal cytology with benign reactive changes

His admission blood results are as follows:
– Hb 145 g/L (normal range: 135-180)
– Platelets 376 * 109/L (normal range: 150-400)
– Total Protein 73 g/L (normal range: 60-83)
– PT 11.2 s (normal range: 11-13.5)
– LDH 145 IU/L (normal range: 135-225)
– Glucose 5.8 mmol/L (normal range: 4-8)
– pH 7.38 (normal range: 7.35-7.45)

What is the most appropriate course of action for managing this patient?

MSFinals-2289

A 50-year-old man presents for a health check and his thyroid function tests (TFTs) from three months ago showed elevated TSH levels and normal Free T4 levels. His recent TFTs show similar results and he reports feeling more tired and cold than usual. He denies any other symptoms and has no past medical history, but his mother has a history of autoimmune thyroiditis. What is the next step in managing his condition?

MSFinals-2290

A 27-year-old construction worker comes to you with a puncture wound that got contaminated with rusted metal while working on a construction site. You want to know if he needs protection against tetanus and find out that he received 5 doses of tetanus vaccine in the past, with the last dose being 6 years ago. What is the recommended course of action for tetanus treatment in this case?