Archives: Medical Student Finals

MSFinals-2089

A 67-year-old man presents to his General Practitioner with a 5-month history of night sweats and weight loss. He has no history of cough, shortness of breath or foreign travel. He denies any back or joint pain. He is normally fit and well, except for high blood pressure for which he takes enalapril. He continues to drink ten units of alcohol per week.
On examination, he is noted to have cervical and groin lymphadenopathy, with an enlarged spleen. The remainder of the examination and observations are normal.
Which of the following is most likely to be used in the management of this patient?

MSFinals-2090

A 65-year-old man comes to the clinic with complaints of haematuria. He has a history of chronic atrial fibrillation and is currently taking warfarin. His blood tests reveal a Hb level of 112g/L and an INR of 9, but he is stable hemodynamically. The consulting physician recommends reversing the effects of warfarin. What blood product/s would be the most appropriate choice for this patient?

MSFinals-2091

A 40-year-old man presents to his GP after discovering a low haemoglobin level during a routine blood donation. He has been experiencing fatigue and breathlessness during mild exertion for the past few weeks. He has donated blood twice before, with the most recent donation being a year ago. He has been taking 30 mg lansoprazole daily for several years to manage his acid reflux, which is well controlled. He also takes cetirizine for hay fever. He denies any nausea, vomiting, changes in bowel habits, or blood in his stools or urine. His diet is diverse, and he is not a vegetarian or vegan. Physical examinations of his chest and abdomen are normal, and urinalysis is unremarkable. The following are his blood test results:
– Haemoglobin: 100 g/l (normal range: 135-175 g/l)
– Mean corpuscular volume (MCV): 72.0 fl (normal range: 82-100 fl)
– White cell count (WCC): 6.1 × 109/l (normal range: 4-11 × 109/l)
– Platelets: 355 × 109/l (normal range: 150-400 × 109/l)
– Ferritin: 6.0 µg/l (normal range: 20-250 µg/l)
– Immunoglobulin A (IgA) tissue transglutaminase antibody (tTGA) is negative, and IgA level is normal.
What is the most appropriate initial management step?

MSFinals-2092

A frequent contributor complains of yellowing of the eyes and fever after donating blood for five days.
What should be the subsequent suitable step for the medical officer in charge of the blood bank?

MSFinals-2093

A 32-year-old woman comes to Haematology complaining of fatigue, anaemia and splenomegaly. She is diagnosed with a genetic disorder that causes abnormal blood cell shape due to a dysfunctional membrane protein. As a result, these cells are broken down by the spleen, leading to haemolytic anaemia and splenomegaly. What is the most probable abnormality observed in a blood film of individuals with this condition?

MSFinals-2094

A 25-year-old woman with sickle-cell disease is being evaluated in Haematology Outpatients. She has been admitted several times due to sickle-cell crisis and abdominal pain, and there is suspicion of multiple splenic infarcts. What blood film abnormalities would indicate hyposplenism?

MSFinals-2095

A 75-year-old woman comes in with a swollen and hot right calf. She had undergone a right knee arthroscopy and had been immobile for a while. She only takes paracetamol and codeine for osteoarthritis as needed. An above-knee deep vein thrombosis (DVT) is detected on ultrasound, which is her first DVT. What is the recommended treatment?

MSFinals-2062

This is the full blood count result of a 72-year-old male who presents with fatigue following his retirement 6 months ago:

Hb 130 g/L (120-160)
RBC 4.5 ×1012/L –
Haematocrit 0.39 (0.36-0.46)
MCV 86.5 fL (80-100)
MCH 28.1 pg (27-32)
Platelets 180 ×109/L (150-400)
WBC 6.5 ×109/L (4-11)
Neutrophils 3.8 ×109/L (2-7)
Lymphocytes 1.9 ×109/L (1-4)
Monocytes 0.5 ×109/L (0.2-1)
Eosinophils 0.2 ×109/L (0-0.5)
Basophils 0.1 ×109/L (0-0.1)

He is brought into the clinic by his wife who is concerned that her husband is constantly tired, has lost interest in his hobbies and has trouble sleeping.

Examination is pretty much normal except that he appears fatigued. There are no abnormalities on chest, abdominal or respiratory examination. Neurological examination is normal.

What is the most likely cause of this blood picture?

MSFinals-2063

A 35-year-old man comes to you seeking advice. He had a splenectomy ten years ago after a cycling accident and has been in good health since. However, a friend recently told him that he should be receiving treatment for his splenectomy. He is currently not taking any medication.

What would you recommend to him?

MSFinals-2064

A 70-year-old man presents with fatigue, pallor and shortness of breath. He has been battling with an indolent colon carcinoma for the past 5 years. He also suffers from insulin-dependent diabetes, hypertension, coronary artery disease and rheumatoid arthritis. He has been feeling unwell for the past few weeks. He denies any history of melaena or haematochezia and has been amenorrhoeic for decades. A bedside stool guaiac test is negative for any blood in the stool. He is well nourished, reports taking daily supplements and is not a vegetarian. He reports that his haematocrit is 0.28 (0.35–0.55) and haemoglobin level 100 g/l (115–155 g/l).
What additional findings would you expect to observe in his full blood count?