Archives: Medical Student Finals

MSFinals-2152

A 62-year-old practising solicitor attends the Neurology Clinic with his wife. She is deeply concerned regarding his worsening memory. Over the past three months, he has become increasingly forgetful, to the point where he has had to take sick leave from work. He has had two recent presentations to the Emergency Department following falls, though a computed tomography (CT) head scan did not demonstrate any abnormality. On examination, there is an ataxic gait and you notice fasciculations and involuntary jerking movements of the upper limbs. He has had no family history of neurological disease and was previously fit and well.
What is the most likely underlying cause of this presentation?

MSFinals-2153

A 50-year-old man has been diagnosed with pulmonary tuberculosis.

Which investigation is crucial before initiating antituberculous treatment?

MSFinals-2154

A 4-year-old girl is brought to the general practitioner (GP) by her parents. She has been experiencing a dry cough with coryzal symptoms. On examination, there is evidence of conjunctivitis and an erythematosus rash on her forehead and neck which is confluent. Oral examination reveals red spots with a white centre on the buccal mucosa, adjacent to the lower second molar tooth. She is currently apyrexial, though her parents state she has been feverish over the past two days. Her heart rate is 80 bpm. No one else in her family is unwell, though her sister did have chickenpox earlier in the month.
What is the most likely cause for this presentation?

MSFinals-2155

A 15-year-old girl arrives at the Emergency department with breathing difficulties. Earlier that day, she had visited her general practitioner for a sore throat and was diagnosed with tonsillitis. The doctor prescribed a five-day course of oral amoxicillin. The patient has a history of ulcerative colitis and takes mesalazine 400 mg tds regularly.

Upon examination, the girl appears distressed with laboured breathing and stridor. She is pale, sweaty, and cyanosed, sitting up with an open mouth and drooling saliva. Her temperature is 39°C, pulse 120/minute and regular, blood pressure 90/35 mmHg. Her lungs are clear.

What is the immediate treatment required for this patient?

MSFinals-2156

A sexually active 25-year-old woman comes to her GP complaining of lower abdominal pain that has been present for two days. She reports that her last menstrual period was six weeks ago and has experienced post coital bleeding along with deep dyspareunia. Upon examination, there is tenderness in the lower abdomen and adnexal tenderness during pelvic examination. What is the most suitable investigation for this patient?

MSFinals-2157

A 35-year-old man was bitten by a stray dog during his travels. The dog bit him on his leg, causing a deep wound with bleeding. The dog appeared sickly and there was a high possibility that it was infected with rabies. As a precautionary measure, the dog was euthanized and its tissues were tested. The results confirmed that the dog was indeed positive for rabies.

What is the recommended course of treatment for this individual?

MSFinals-2158

A 30-year-old woman, who is 20 weeks’ pregnant, presents to the Emergency Department with concerns about her exposure to chickenpox. She recently spent time with her niece who was diagnosed with the virus. The patient is worried about the potential impact on her pregnancy and reports having had chickenpox as a child. Upon examination, there is no rash present. What is the best course of action to address the patient’s concerns?

MSFinals-2159

A 4-year-old girl is brought to the Emergency department with a red rash. Her mother reports that it started behind her ears and then spread down her head and neck before spreading to the rest of her body. The mother is unsure if her daughter has received all of her vaccinations. Upon further questioning, the mother reveals that her daughter had been feeling unwell with cold-like symptoms and a low-grade fever in the week leading up to the rash.
During the examination, you observe grey/white spots in the girl’s mouth and throat, indicating an infectious illness. What is the most severe complication that can arise from this illness?

MSFinals-2160

A 25-year-old graduate is referred to the renal clinic by the local health center. She has poorly controlled hypertension despite taking 10 mg of ramipril and 5 mg of amlodipine. Her medical history reveals recurrent urinary tract infections during childhood and recent use of ibuprofen for a knee injury. On examination, her blood pressure is 178/95 mmHg, pulse is regular at 74 bpm, and BMI is 22 kg/m2. Her creatinine level is elevated at 178 μmol/L. What is the most likely reason for her presentation?

MSFinals-2161

A 75-year-old woman complains of an itchy rash on her hands, anterior aspects of both elbows, axillae and groins. Several other residents in her nursing home have reported similar symptoms.

What could be the possible diagnosis?