Archives: Medical Student Finals

MSFinals-2050

A 35-year-old man presents with progressive weakness in his right upper limb and both lower limbs over the past four months. He has also developed digital infarcts affecting the second and third fingers on the right hand and the fifth finger on the left. On examination, his blood pressure is 160/140 mm Hg, all peripheral pulses are palpable, and there is an asymmetrical neuropathy. Laboratory investigations reveal a haemoglobin level of 120 g/L (130-170), a white cell count of 12.5 ×109/L (4-10), a platelet count of 430 ×109/L (150-450), and an ESR of 50 mm/hr (0-15). Urine examination shows proteinuria and 10-15 red blood cells per high power field without casts. What is the most likely diagnosis?

MSFinals-2051

A 62-year-old woman is being evaluated in the pre-operative clinic for an elective cholecystectomy. She has no other medical conditions except for two episodes of cholecystitis within the past year. Additionally, she has never undergone a blood transfusion before. What information should be included in the request to the blood bank?

MSFinals-2052

A 14-year-old girl presents to the clinic with her parents. She is worried about not having started her periods yet, while many of her peers have. Her medical history includes a lack of sense of smell, which she has had since childhood. On examination, she has normal height, early breast development, and minimal secondary sexual hair. Her BMI is 22. What blood test would be most helpful in determining the underlying cause of her amenorrhea?

MSFinals-2053

A middle-aged woman presents with increasing fatigue and daytime exhaustion that is starting to affect her work as a receptionist. She has been referred to the gynaecology clinic for evaluation of menorrhagia. What results would you anticipate on her complete blood count (CBC)?

MSFinals-2054

A 68-year-old man who has been diagnosed with severe Gram-positive sepsis is admitted to the Intensive Care Unit (ICU). However, he is starting to deteriorate despite being on the Sepsis Six Bundle. He is pyrexial and appears very unwell. On examination:
Investigation Results Normal value
Respiratory rate (RR) 30 breaths/minute 12–18 breaths/minute
Heart rate (HR) 120 bpm 60–100 bpm
Blood pressure (BP) 88/40 mmHg < 120/80 mmHg
You noted some bleeding along the cannulation site and on his gums. The coagulation profile showed prolonged prothrombin time, a decrease in fibrinogen level and marked elevation of D-dimer. He has some purpuric rash on his extremities.
Which of the following is the most likely cause of the above condition?

MSFinals-2055

A middle-aged patient is newly diagnosed with a bleeding disorder after complaining of heavy periods. She presents with a prolonged APTT and bleeding time, but normal indices. The patient reports a family history of bleeding disorders on her mother’s side. She denies any prior history of bleeding or bruising after minor surgical procedures. What is the most likely bleeding disorder in this patient?

MSFinals-2057

A 48-year-old man was admitted with unconsciousness.
On examination, his left plantar response was extensor, and deep tendon jerks were increased on the left side. A computerised tomography (CT) scan of the brain revealed a right-middle cerebral artery territory infarct. He was not known to have diabetes or hypertension. He was not receiving any drugs, either.
His blood count revealed:
Investigation Result Normal value
Haemoglobin 110 g/l 135–175 g/l
White cell count (WCC) 331 × 109/l 4–11 × 109/l
Neutrophil count 145 × 109/l 2.5–7.58 × 109/l
Metamyelocyte 3000/mm3
Platelet 490 × 109/l 150–400 × 109/l
Peripheral smear Many band forms, myelocytes, basophils
What is the next appropriate therapy?

MSFinals-2058

A 31-year-old man presented with weakness and fatigue. On examination, he was emaciated with a body weight of 40 kg. Blood tests revealed abnormalities including low haemoglobin, low MCV, low MCH, high platelet count, low albumin, and low calcium. His peripheral blood showed Howell-Jolly bodies. To which department should this patient be referred?

MSFinals-2059

A 25-year-old female presents with severe anaemia and a skull x-ray shows a ‘hair on end’ appearance. Where is this appearance most commonly observed on a skull x-ray?