Archives: Medical Student Finals

MSFinals-6395

A 50-year-old woman comes to the clinic with creamy nipple discharge. She had a mammogram screening a year ago which was normal. She smokes 10 cigarettes per day. Upon examination, there were no alarming findings. A repeat mammogram was conducted and no abnormalities were detected. Although she is concerned about the possibility of a tumor, she is not bothered by the discharge itself. Her serum prolactin level is provided below.
Prolactin 200 mIU/L (<600)
What is the most probable diagnosis and what would be the best initial treatment?

MSFinals-6396

A 21-year-old man comes to his GP with scrotal swelling and pain that has been developing for the past three days. Upon examination, the testes are palpable but tender to touch, and the scrotum is red and warm. What is the initial investigation that should be performed?

MSFinals-6397

A 24-year-old male presents to the emergency department after crashing his motorcycle into a bus stop. He is alert and oriented to person, place, and time, but reports extreme pain in multiple areas. On physical examination, he exhibits tenderness and pain in his right leg, significant abdominal bruising, and diffuse tenderness over his ribcage. His vital signs are as follows: heart rate of 105 beats/min, blood pressure of 105/62 mmHg, respiratory rate of 20 breaths/min, and SpO2 of 98% on room air. Imaging reveals multiple fractures, including a fractured right femur, multiple fractured ribs, and a fractured left tibia. The patient is consented and sent for emergency surgery. Which induction agent is the most preferable for anesthesia?

MSFinals-6398

Which of the subsequent anaesthetic agents possesses the most potent analgesic effect?

MSFinals-6399

A 65-year-old man presents with urinary problems. He has been passing very frequent small amounts of urine and has also been getting up several times in the night to urinate.

Upon examination, he has a smooth, non-enlarged prostate, and no abdominal masses. Further investigation rules out diabetes, infection, and urological malignancy. It is determined that his symptoms are due to an overactive bladder. Lifestyle advice is discussed, and he is referred for bladder training exercises.

What should be the next course of action?

MSFinals-6400

A 58-year-old man comes to see his GP with complaints of worsening urinary symptoms. He reports frequent urges to urinate throughout the day and has experienced occasional incontinence. He denies any hesitancy, dribbling, or weak stream. Despite trying bladder retraining, he has seen little improvement.

During the examination, the GP notes that the man’s prostate is smooth, regular, and not enlarged. A recent PSA test came back normal. The patient has no medical history and is not taking any regular medications.

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

MSFinals-6373

A 65-year-old patient arrives at the emergency department with complaints of abdominal pain and distention. They have not had a bowel movement in 4 days and have not passed gas in 1 day. During the examination, hyperactive bowel sounds are heard, and a digital rectal exam reveals an empty rectum. An urgent CT scan of the abdomen and pelvis with contrast reveals a suspicious large localized lesion in the descending colon, causing bowel obstruction and severely dilated bowel loops.

What is the most appropriate initial surgical option for this patient?

MSFinals-6376

A 25-year-old man comes to his doctor complaining of rectal pain that has been bothering him for the past 4 days. He describes the pain as sharp and shooting, and it gets worse when he has a bowel movement or engages in anal sex. The patient has a history of constipation. During the examination, a small tear is visible on the posterior aspect of the anal margin. The doctor offers the patient appropriate pain relief. What is the best initial course of action?

MSFinals-6377

A 36-year-old man presents to the emergency department following a fall from a ladder of approximately 2.5 meters. According to his wife, he lost consciousness for around 30 seconds before regaining it. The paramedics who attended the scene noted that he had vomited once and had a GCS of 14 due to confused speech, which remains the same. Upon examination, he has a laceration on his head, multiple lacerations on his body, and a visibly broken arm. However, his cranial nerve, upper limb, and lower limb neurological examinations are normal. What aspect of his current condition warrants a head CT?

MSFinals-6378

A 75-year-old patient with prostate cancer is initiated on goserelin therapy. After a week of starting the treatment, he visits a nearby emergency department with complaints of aggravated lower urinary tract symptoms and newly developed back pain. What could have been done to prevent this deterioration?