Archives: Medical Student Finals

MSFinals-2032

A 43-year-old woman was diagnosed with acute myeloid leukaemia (AML) with 71% of bone marrow blasts. She declined bone marrow transplant and was started on appropriate chemotherapy. After 2 months, a repeat bone marrow revealed 8% of blasts. Peripheral blood was blast-free and blood tests revealed:
Investigation Result Normal value
Haemoglobin 106 g/l 115–155 g/l
White cell count (WCC) 8.1 × 109/l 4–11 × 109/l
Neutrophils 5.2 × 109/l 2.5–7.58 × 109/l
Lymphocytes 1.8 × 109/l 1.5–3.5 × 109/l
Platelets 131 × 109/l 150–400 × 109/l
What is her clinical status?

MSFinals-2033

The most common error in transfusion according to the SHOT (serious hazards of transfusion) analysis?

MSFinals-2035

A worried mother brings her 7-year-old son to the Emergency Department as she is concerned about his left knee. The child injured his knee while playing outside, and the knee is now significantly swollen and he is experiencing a lot of pain. The mother mentions that the child bruises easily. The mother herself does not have any such issues, but her sister had similar problems when she was young.
What is the most probable pathophysiologic mechanism responsible for this boy’s symptoms?

MSFinals-2036

A 54-year-old white woman without past medical history presents with pallor, shortness of breath, palpitations and difficulty balancing.
On examination, her vitals are heart rate 110 bpm at rest and 140 bpm on ambulation, blood pressure 100/60 mmHg, respiratory rate 18 breaths/minute, temperature 37 ° C and oxygen saturation 98% on room air. She is pale. Her lungs are clear to auscultation; her heart rate is regular without murmurs, rubs or gallops; her abdomen is soft and non-tender; she is moving all extremities equally, and a stool guaiac test is heme-negative. Her gait is wide and she has difficulty balancing. She has decreased sensation to fine touch in her feet. Her mini-mental status exam is normal.
Blood work shows:
Haematocrit: 0.19 (0.35–0.55)
Mean cell volume: 110 fl (76–98 fl)
White blood cell count: 5 × 109/l (4–11 × 109/l)
Which one of the following findings would most likely lead to the correct diagnosis?

MSFinals-2037

A 36-year-old woman, who has received a 3-unit blood transfusion following a hysterectomy, begins to feel unwell with a fever and chills 3 or 4 days later. There are no obvious signs of active bleeding. On examination, you note that she is mildly jaundiced.
Investigations:
Investigation Result Normal value
Pre-transfusion haemoglobin (Hb) 92 g/l 115–155 g/l
Post-transfusion Hb 98 g/l 115–155 g/l
Platelets 180 × 109/l 150–400 × 109/l
White cell count (WCC) 7.2 × 109/l 4–11 × 109/l
Sodium (Na+) 138 mmol/l 135–145 mmol/l
Potassium (K+) 4.9 mmol/l 3.5–5.0 mmol/l
Creatinine 130 μmol/l 50–120 µmol/l
Bilirubin 90 μmol/l 2–17 µmol/l
Alanine aminotransferase (ALT) 50 IU/l 5–30 IU/l

What is the most likely diagnosis for this 36-year-old woman who has received a 3-unit blood transfusion following a hysterectomy and is experiencing fever, chills, and mild jaundice without signs of active bleeding?

MSFinals-2038

A 70-year-old woman comes to the clinic complaining of fatigue and overall weakness. She denies any other symptoms. Upon examination, the patient has conjunctival pallor and an inflamed, red tongue. Initial blood tests show a macrocytic anemia. Further testing reveals positive antiparietal cell antibodies.
What result is most likely to be found upon further investigation?

MSFinals-2039

A 32-year-old male patient complained of frequent nosebleeds and was diagnosed with iron deficiency anemia. During a chest x-ray, a shadow was detected over the right lung base, and a bruit was heard upon auscultation in the same area. What is the most probable diagnosis?

MSFinals-2040

A 35-year-old woman is brought to the Emergency Department after consuming 30 tablets of warfarin which belonged to her mother. She has diarrhoea but has no mucosal bleeding. She admits to previously attending a psychiatric unit for self-harming behaviour. She has no remarkable medical history. Her mother has a history of recurrent venous thrombosis for which she is taking warfarin.
What will the patient’s coagulation screen likely be?

MSFinals-2041

A 60-year-old man comes to his doctor with complaints of night sweats and unintended weight loss. He has a medical history of axillary lymphadenopathy. The doctor suspects that he may have non-Hodgkin’s lymphoma. What is the most probable test to confirm this diagnosis?