Archives: Medical Student Finals

MSFinals-2065

A 45-year-old Afro-Caribbean man presents to the Emergency Department with acute severe chest pain, fever and a cough, which he has had for five days. Examination revealed signs of jaundice and the spleen was not big enough to be palpable.
You take some basic observations:
Temperature: 38 °C
Respiratory rate: 26 breaths/min
O2 saturation: 86%
Heart rate: 134 bpm (regular)
Blood pressure (lying): 134/86 mmHg
Blood pressure (standing): 132/90 mmHg
His initial investigation findings are as follows:
Investigation Result Normal
White cell count (WCC) 13.8 × 109/l 4–11.0 × 109/l
Neutrophils 7000 × 106/l 3000–5800 × 106/l
Lymphocytes 2000 × 106/l 1500–3000 × 106/l
Haemoglobin (Hb) 105 g/l 135–175 g/l
Mean corpuscular volume (MCV) 110 fl 76–98 fl
Platelets 300 × 109/l 150–400 × 109/l
Troponin l 0.01 ng/ml < 0.1 ng/ml
D-dimer 0.03 μg/ml < 0.05 μg/ml
Arterial blood gas (ABG) showed type 1 respiratory failure with a normal pH. Chest X-ray showed left lower lobe consolidation.
The patient was treated successfully and is due for discharge tomorrow.
Upon speaking to the patient, he reveals that he has suffered two similar episodes this year.
Given the likely diagnosis, what medication should the patient be started on to reduce the risk of further episodes?

MSFinals-2066

A plasma donor on a continuous flow separator machine experiences light headedness, muscle cramps, and circumoral paraesthesia. What should be the next course of action in managing this patient?

MSFinals-2067

As a part of a haematology rotation, a final-year medical student is asked to give a PowerPoint presentation to the team about a 20-year-old patient who presented with sickle-cell crisis.
With regard to sickle-cell disease, which of the following statements is correct?

MSFinals-2068

A 10-year-old Afro-Caribbean boy has been brought to the paediatric Emergency Department by his parents, both of whom are known to suffer from sickle cell disease. They have brought him in to see you because they are worried he has developed ‘septicaemia’. Upon further questioning, he reveals that he has developed extreme fatigue, shortness of breath on exertion, coryzal symptoms and bleeding gums, all over the last two days.
Upon examination, you note an erythematosus rash on both cheeks, a small purpuric rash on the left arm, pale conjunctivae, pale skin and well-perfused peripheries. Brudzinski’s sign is negative.
You take some basic observations, which are as follows:
Temperature: 37.8 ˚C
Heart rate: 100 bpm (normal 55–85 bpm)
Respiratory rate: 20 breaths/min (normal 12–18 breaths/min)
Blood pressure: 130/86 mmHg (lying), 132/84 mmHg (standing)
Oxygen saturation: 98% on room air
His initial investigation findings are as follows:
Investigation Result Normal
White cell count (WCC) 11.4 × 109/l 4–11 × 109/l
Neutrophils 3800 × 106/l 3000–5800 × 106/l
Lymphocytes 7200 × 106/l 1500–3000 × 106/l
Haemoglobin (Hb) 84 g/dl 135–175 g/l
Mean corpuscular volume
(MCV) 94 fl 76–98 fl
Platelets 200 × 109/l 150–400 × 109/l
Given the likely diagnosis, how should the patient be managed?

MSFinals-2069

A patient who is seen in the Renal Outpatient Department for glomerulonephritis presents to the Emergency Department with a swollen, erythematosus right leg with a 4-cm difference in circumference between the right and left leg. Routine blood tests show:
Investigation Result Normal value
Sodium (Na+) 143 mmol 135–145 mmol/l
Potassium (K+) 4.2 mmol 3.5–5.0 mmol/l
Urea 10.1 mmol 2.5–6.5 mmol/l
Creatinine 120 μmol 50–120 µmol/l
eGFR 60ml/min/1.73m2
Corrected calcium (Ca2+) 2.25 mmol 2.20–2.60 mmol/l
Bilirubin 7 μmol 2–17 µmol/l
Albumin 32 g/l 35–55 g/l
Alkaline phosphatase 32 IU/l 30–130 IU/l
Aspartate transaminase (AST) 15 IU/l 10–40 IU/l
Gamma-Glutamyl transferase (γGT) 32 IU/l 5–30 IU/l
C-reactive protein (CRP) 15 mg/l 0–10 mg/l
Haemoglobin 78 g/l
Males: 135–175 g/l
Females: 115–155 g/l
Mean corpuscular volume (MCV) 92 fl 76–98 fl
Platelets 302 x 109/l 150–400 × 109/l
White cell count (WCC) 8.5 x 109/l 4–11 × 109/l
Which of the following should be commenced after confirmation of the diagnosis?

MSFinals-2070

Which structure, containing both white and red pulp, is responsible for trapping foreign substances present in the blood?

MSFinals-2071

A 67-year-old man presented with fever and body ache for 6 months. His blood tests revealed a haemoglobin level of 110 g/l and erythrocyte sedimentation rate (ESR) of 121 mm in the first hour. Serum protein electrophoresis revealed an M band in the gamma globulin region with a total IgG level of 70 g/l. Bone marrow biopsy shows plasma cells in the marrow of 11%. A skeletal survey reveals no abnormalities. Other blood tests revealed:
Test Parameter Normal range
Calcium 2.60 mmol/l 2.20–2.60 mmol/l
Creatinine 119 μmol/l 50–120 μmol/l
Phosphate 1.30 mmol/l 0.70–1.40 mmol/l
Potassium (K+) 4.6 mmol/l 3.5–5.0 mmol/l
Lactate dehydrogenase 399 IU/l 100–190 IU/l
His body weight was 80 kg.
What is his condition better known as?

MSFinals-2072

A 65-year-old African-American has marked left-sided weakness and an expressive aphasia. He is diagnosed with a stroke. Blood results show the following:
Investigation Result Normal value
Haemoglobin (Hb) 90 g/l 135–175 g/l
Platelets 80 × 109/l 150–400 × 109/l
calcium 3.80 mmol/l 2.20–2.60 mmol/l
creatinine 128 µmol/l 50–120 µmol/l
Which investigation is likely to reveal the cause of this man’s stroke?

MSFinals-2073

A 67-year-old man was admitted with pain in the left groin. He had fallen from his chair, after which the pain started. He was unable to walk and his left leg was externally rotated. X-rays revealed a neck of femur fracture. He lives alone in a flat and is a vegetarian. His past medical history includes shortness of breath, body itching and occasional swelling of legs. His blood tests revealed:
Investigation Result Normal range
Haemoglobin 120 g/l 135–175 g/l
Calcium 3.5 mmol/l 2.20–2.60 mmol/l
Phosphate 1.52 mmol/l 0.70–1.40 mmol/l
Erythrocyte sedimentation rate (ESR) 184 mm/h 0–15 mm/h
What is the most likely diagnosis?

MSFinals-2074

A 70-year-old man presents with increasing shortness of breath on exertion. He also notes he has been bruising more easily of late. He is noted to be in sinus tachycardia but otherwise is haemodynamically stable. Examination reveals conjunctival pallor and hepatosplenomegaly. No definite lymphadenopathy is palpable. A full blood count is performed:
Investigation Result Normal value
Haemoglobin 69 g/l 135–175 g/l
White cell count (WCC) 0.7 × 109/l 4.0–11.0 × 109/l
Platelets 14 × 109/l 150–400 × 109/l
Blood film is reported as a leukoerythroblastic picture with teardrop-shaped erythrocytes. A bone marrow aspirate is attempted, but this is unsuccessful.
What is the likely diagnosis?