A 25-year-old patient presented with red rashes on their feet. Upon examination, they were found to be pale with purpuric spots on their lower legs. Their temperature was 38.3 °C and they also complained of nausea. On the second day of admission, their fever increased and they became disoriented. New bleeding spots started appearing on their face. Blood reports revealed low hemoglobin, high white cell count, low platelets, and high creatinine levels. A peripheral blood smear showed helmet cells and anisocytosis. The CSF study was normal. What test should be done next for this patient?
MSFinals-2108
A 72-year-old man experiences sudden paralysis on the right side of his body. He has been a smoker for 30 years, consuming 15 cigarettes a day. His vital signs are as follows: temperature 37.2°C, pulse 80/minute, respiratory rate 18/minute, and blood pressure 150/95 mm Hg. An angiogram of the brain shows blockage in a branch of the middle cerebral artery. Laboratory results indicate a haemoglobin A1c level of 80 mmol/mol (9.5%). Which component of blood lipids is the most significant factor in contributing to his condition?
MSFinals-2109
A 50-year-old patient presents to the general practitioner with a complaint of darkening of urine, particularly noticeable in the morning. The patient has no family history of bleeding disorders and was recently hospitalized for deep venous thrombosis in the right leg. Upon examination, the patient’s heart and lungs appear normal. Blood tests reveal anemia, elevated levels of lactate dehydrogenase (LDH), high bilirubin levels, and a high reticulocyte count. What is the most likely cause of this patient’s condition?
MSFinals-2110
A 68-year-old woman is admitted to Accident and Emergency with a massive upper gastrointestinal haemorrhage. She has a history of atrial fibrillation and is on warfarin. Since admission, she has had several episodes of copious haematemesis. Her blood pressure is 80/54 mmHg, and her heart rate is 136 beats/min. You have started resuscitation with normal saline and have ordered a group and save and a crossmatch. Her INR is currently 8.4. What is the most appropriate way to manage her INR?
MSFinals-2096
A 91-year-old woman with known vascular dementia presents to the Emergency Department after a routine blood test uncovered that the patient had a sodium level of 149 mmol/l. Her carer comments that the patient’s fluid intake has been minimal over the past week. The patient’s past medical history includes a previous lacunar stroke and peripheral vascular disease. Her regular medications are atorvastatin, ramipril, amlodipine and clopidogrel. She currently is fully dependent on the assistance provided by carers. The patient’s National Early Warning (NEWS) score is 0, and her Glasgow Coma Scale (GCS) score is 15. A physical examination does not reveal any source of infection. A bedside capillary glucose is recorded as 5.8 mmol/mmol. A full set of blood tests are repeated, reported as follows: Full blood count and urea and electrolytes (U&Es): Investigations Results Normal Values Haemoglobin (Hb) 131 g/l 115–155 g/l Mean corpuscular volume (MCV) 91 fl 76–98 fl White cell count (WCC) 5 × 109/l 4–11 × 109/l Platelets (Plt) 215 × 109/l 150–400 × 109/l Sodium (Na+) 148 mmol/l 135–145 mmol/l Potassium (K+) 4.8 mmol/l 3.5–5.0 mmol/l Urea 3.3 mmol/l 2.5–6.5 mmol/l Creatinine 66 mmol/l 50–120 mmol/l A routine chest X-ray and urinalysis are performed and show no abnormalities. Which of the following is the most suitable to correct the patient’s hypernatraemia?
MSFinals-2097
A 14-year-old girl presents with a history of easy bruising and excessive bleeding after a dental procedure. She is diagnosed with von Willebrand’s disease and is scheduled for additional dental extractions. The physician prescribes DDAVP. What is the mechanism of action of DDAVP in treating von Willebrand’s disease?
MSFinals-2098
A 35-year-old woman visits her GP complaining of fatigue that has lasted for 2 months. She has been consuming approximately 20 units of alcohol per week for the past decade. Her blood test reveals the following results: Investigation Result Normal value Haemoglobin (Hb) 98 g/l 115–155 g/l Mean corpuscular volume (MCV) 126 fl 82–100 fl What is the most probable cause of her anaemia based on these blood results?
MSFinals-2099
What is true for a patient with blood type group O before receiving a blood transfusion?
MSFinals-2100
What is the appropriate management for a 65-year-old woman with confusion, profuse sweating, bluish discoloration of toes and fingertips, and a petechial rash on the left side of her anterior abdominal wall, who has a history of dysuria and was prescribed antibiotics by her GP three days ago, and is now found to have disseminated intravascular coagulation (DIC) based on her blood results?
MSFinals-2078
A young man comes to the clinic complaining of fatigue, tiredness, and pallor. Upon conducting a full blood count, it is revealed that he has acute lymphoblastic leukemia. Among the following options, which is linked to the poorest prognosis in ALL?