Archives: Medical Student Finals

MSFinals-2252

A 16-year-old female presents to the emergency department with peri-umbilical pain. The pain is sharp in nature, is exacerbated by coughing and came on gradually over the past 12 hours. On examination, she is unable to stand on one leg comfortably and experiences pain on hip extension. The is no rebound tenderness or guarding. A urine pregnancy test is negative, and her temperature is 37.4ºC. The following tests are done:

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

Platelets 300 * 109/L (150 – 400)

WBC 14 * 109/L (4.0 – 11.0)

Neuts 11 * 109/L (2.0 – 7.0)

Lymphs 2 * 109/L (1.0 – 3.5)

Mono 0.8 * 109/L (0.2 – 0.8)

Eosin 0.2 * 109/L (0.0 – 0.4)

Na+ 136 mmol/L (135 – 145)

K+ 4 mmol/L (3.5 – 5.0)

Urea 6 mmol/L (2.0 – 7.0)

Creatinine 80 µmol/L (55 – 120)

CRP 24 mg/L (< 5) What is the most likely diagnosis?

MSFinals-2215

A 54-year-old man complains of fatigue, overall weakness, and weight loss for the past 3 months. He also reports experiencing pain in his second and third fingers for the last month and worsening erectile dysfunction. You suspect that he may have hereditary hemochromatosis and order blood tests. Which of the following results would support your suspected diagnosis?

MSFinals-2216

An 80-year-old man is hospitalized with community-acquired pneumonia (CAP) and develops acute kidney injury (AKI) on the third day of admission. His eGFR drops from 58 to 26 ml/min/1.73 m2 and creatinine rises from 122 to 196 umol/L. Which of his usual medications should be discontinued?

MSFinals-2217

A 78-year-old man presents to the emergency department with a 2-day history of vomiting and abdominal pain. He has a medical history of heart failure and COPD. Upon examination, his abdomen is soft and non-tender, and his vital signs are as follows: blood pressure 105/72 mmHg, pulse 94 bpm, respiratory rate 14/min, and temperature 36.9 deg C. His initial blood tests reveal hyponatremia with a sodium level of 123 mmol/L (135 – 145). What is the best approach to manage this patient’s hyponatremia?

MSFinals-2218

A 50-year-old woman comes to the doctor’s office complaining of a recent experience where she suddenly smelled roses while at work. The sensation lasted for about a minute, during which her left arm twitched. Her colleagues noticed that she seemed to be daydreaming during the episode. She remembers the event clearly and did not lose consciousness. What is the probable diagnosis?

MSFinals-2219

A 28-year-old individual visits the neurology clinic with complaints of experiencing multiple instances of involuntary shaking in different limbs. They have some control over which limb is affected the most but are unable to stop the shaking. The intensity of the shaking increases gradually and then subsides in a similar manner. The patient reports that the shaking is more severe when they feel anxious. What is the probable diagnosis?

MSFinals-2220

A 35-year-old man with a history of chronic alcohol abuse presents to the Emergency Department. He appears disheveled, disoriented, and experiences frequent falls. Upon examination, you observe that he has difficulty with balance and coordination, and bilateral lateral rectus palsy with nystagmus. His sensory examination reveals a polyneuropathy, and his pulse is 90 bpm. There is no agitation or tremor noted on examination.
What is the most urgent treatment that should be administered to this patient?

MSFinals-2221

A 12-year-old girl is brought to the hospital with lethargy and diarrhoea during a local outbreak of E coli 0157:H7. Her initial blood tests reveal acute renal failure, indicating a possible diagnosis of haemolytic uraemic syndrome. What investigation result would be anticipated in this case?

MSFinals-2222

A 67-year-old woman presents with symptoms of fatigue. Routine blood tests reveal Hb of 105 g/L, MCV of 104 fL, platelets of 305 * 109/L, and WBC of 9.3 * 109/L. Further tests reveal positive intrinsic factor antibodies. During the discussion of the diagnosis with the patient, the potential serious complications are brought up. What is one serious complication that can arise from this condition?

MSFinals-2223

A 42-year-old man visits his GP complaining of jaundice that has been present for 2 days. He has a medical history of Crohn’s disease and type 2 diabetes mellitus. The patient takes metformin, sitagliptin, infliximab, and bisoprolol regularly. He recently completed a course of clindamycin for a lower limb cellulitis and started taking glipizide for poor glycaemic control. The patient has unconjugated hyperbilirubinaemia and recalls experiencing a similar episode of jaundice as a child after consuming fava beans. Which medication is the most likely cause of the patient’s jaundice?