Archives: Medical Student Finals

MSFinals-2179

A patient in their 60s presents to the emergency department with right-sided hemiplegia, facial weakness, and difficulty with speech. A stroke is suspected. What is the recommended tool for assessing a patient in this scenario?

MSFinals-2180

A 32-year-old man presents to his GP with persistent symptoms three weeks after a flare of ulcerative colitis. Despite daily use of topical mesalazine, he reports passing stool with a small amount of blood up to three times daily. His vital signs are within normal limits, and blood tests reveal elevated WBC and ESR levels. What is the most appropriate next step in managing this patient?

MSFinals-2144

A 42-year-old man, known to have human immunodeficiency virus (HIV), attends his regular clinic appointment. He has missed an earlier appointment and is poorly compliant with his antiretroviral therapy, which he puts down to his busy work schedule. He has recently noticed blotches on his nose. His partner reports that the patient also has similar lesions on his back.
On examination, you note several red-purple papules across the patient’s back and face.
Which of the following viruses may have caused these lesions?

MSFinals-2146

A 32-year-old woman is diagnosed with advanced HIV disease. What is involved in strategic planning with antiretroviral medications?

MSFinals-2147

A 29-year-old man from Manchester presents to you with a complaint that he has been treated for oral thrush by one of your colleagues for several months, but the topical treatment has not been effective. He is currently taking an oral anticoagulant for a DVT that occurred without any apparent cause, and has recently experienced an outbreak of shingles. He has not taken any antibiotics recently and has recently separated from his long-term male partner. Upon examination, he appears to be thin and has typical Candida on his tongue and palate. Which test would be the most appropriate to perform in this case?

MSFinals-2148

A 25-year-old woman presents with a nine-week history of fever. She has been experiencing daily temperatures up to 40°C, malaise, and occasional aches in the hands and knees. She also noticed a transient pink rash on her abdomen. Her GP prescribed a one-week course of ampicillin, but it had little effect. On examination, she has a temperature of 38.9°C, a pulse of 110 per minute, and a faint systolic ejection murmur. Her spleen is palpable 3 cm below the left costal margin. Her haemoglobin level is 115 g/L, and her white cell count is 12.8 ×109/L. Her ASO titre is 250 units, and her rheumatoid factor and ANF are negative. Blood cultures have been requested but are not yet available. What is the most likely diagnosis?

MSFinals-2149

A 19-year-old female has suffered a minor cut on her right hand while gardening. She has received all necessary immunisations. What is the most appropriate course of action for tetanus prevention?

MSFinals-2150

A 35-year-old man with HIV disease visits the clinic with complaints of fatigue and weakness. His lab results, taken eight weeks apart, are shown below.

Results 1:
Hb – 145 g/L
WBC – 4.0 ×109/L
Platelets – 70 ×109/L
CD4 – 120 cells/mm3

Results 2:
Hb – 76 g/L
WBC – 4.3 ×109/L
Platelets – 200 ×109/L
CD4 – 250 cells/mm3

The normal ranges for these values are:
Hb – 130-180 g/L
WBC – 4-11 ×109/L
Platelets – 150-400 ×109/L

What is the most likely explanation for these results?

MSFinals-2151

An 82-year-old man has presented to the Emergency Department, following a 3-day history of progressive shortness of breath, productive cough and fever. His past medical history is significant for type II diabetes, currently controlled with metformin. He is a non-smoker, denies recent travel and has no regular contact with animals.
An examination is performed, which reveals a heart rate of 91 bpm, a blood pressure of 98/59 mmHg, a temperature of 38.2 °C and a respiratory rate of 22 breaths/minute. Coarse crackles are heard on auscultation of the right lower lobe. A chest X-ray is performed, which confirms the presence of a right lower lobe pneumonia. The patient is admitted to the Respiratory Ward for intravenous (IV) empirical antibiotics and fluid resuscitation. A sputum culture result has been received two days later:
Investigation Result
Sputum
Rust-coloured sputum
After two days of growth, a Gram-positive spherical bacterium which tends to grow in chains is observed
Partial haemolysis is observed on blood agar plate
Which of the following organisms is the most likely responsible for the patient’s pneumonia?