Archives: Medical Student Finals

MSFinals-6806

A 28-year-old man and his 26-year-old wife visit their GP for a follow-up appointment regarding their difficulty in conceiving. The couple has been trying to conceive for the past year without success. The wife has a regular menstrual cycle and no previous gynaecological issues. An ovulation test measuring her progesterone level showed normal ovulation. The GP advises the couple that the husband needs to undergo tests to determine if there is any cause on his side contributing to the infertility. Both the man and the woman have no history of sexually transmitted infections. The man has been smoking one to two cigarettes a day since he was 16 years old. What is the best next investigation for this patient?

MSFinals-6816

You have organized a semen analysis for a 37-year-old man who has been experiencing difficulty in conceiving with his partner for the past year. The results are as follows:

– Semen volume 1.8 ml (1.5ml or more)
– pH 7.4 (7.2 or more)
– Sperm concentration 12 million per ml (15 million per ml or more)
– Total sperm number 21 million (39 million or more)
– Total motility 40% progressively motile (32% or more)
– Vitality 68% live spermatozoa (58% or more)
– Normal forms 5% (4% or more)

His partner is also undergoing investigations, and you plan on referring him to fertility services. What steps should be taken based on these semen analysis results?

MSFinals-6817

A 67-year-old woman visits her GP complaining of urinary incontinence. She experiences this symptom throughout the day and has noticed that her urine flow is weak when she does manage to go voluntarily. During the examination, the GP detects a distended bladder despite the patient having just urinated before the appointment. What is the probable diagnosis for this woman’s condition?

MSFinals-6809

A 28-year-old man comes to the Emergency Department complaining of pain in his left testicle that has been gradually increasing over the past 72 hours. He appears to be in discomfort but is able to walk. Upon examination, his left testicle is tender to firm palpation. His vital signs are normal, and there is no redness or swelling. His abdominal examination is unremarkable. He reports dysuria and has recently started a new sexual relationship.

What is the most suitable course of action?

MSFinals-6801

A 35-year-old man presents with a right inguinal mass. Upon examination, the left testis is found to be normal in size and position, but the right testis cannot be palpated in the scrotum. An ultrasound confirms that the inguinal mass is a cryptorchid testis.
What is the best course of action for addressing this patient’s testicular anomaly?

MSFinals-6799

You are reviewing a physically fit 78 year old gentleman in the urology outpatient clinic. He initially presented to his GP with an episode of frank haematuria. Urinalysis revealed ongoing microscopic haematuria. Following referral to the urologist, a contrast MRI scan reveals a solitary low risk non-muscle invasive bladder cancer.
Which of the following would be the most appropriate treatment?

MSFinals-6800

A 32-year-old woman presents with a sudden-onset, severe, sharp, colicky pain in the right iliac fossa, radiating to the right loin and her right labia. Her last menstrual period was two weeks ago.
Which of the following would be most useful as an initial investigation?

MSFinals-6798

You are asked to review a middle-aged man, following an admission for lower abdominal pain. The patient has a distended abdomen and has not passed urine for eight hours. He is very uncomfortable and has a large palpable bladder extending above the pubic symphysis. A digital rectal examination is performed, which reveals an enlarged, smooth prostate. Urinalysis is unremarkable, and he remains systemically well. He describes increasing difficulty with voiding and poor stream over the past six months, but no other symptoms.
What is the most likely underlying cause for his urinary retention?

MSFinals-6791

A 58-year-old man presents to his Emergency Department complaining of blood in his urine. He reports that this has been happening over the past three days. He denies any pain or fever.
Physical examination revealed bilateral wheezes but is otherwise unremarkable. He does not have any problem passing urine. He has always lived in the UK and has not travelled anywhere outside the country recently. The patient is retired but used to work in a textile factory where he was responsible for working in the dye plants producing different coloured fabric. He has a past medical history of chronic obstructive pulmonary disease (COPD) and hypertension. He takes losartan for his hypertension and a budesonide and formoterol combination inhaler for his COPD. The man is an ex-smoker with a 30 pack-year smoking history.
What is the most likely diagnosis in this patient?

MSFinals-6793

A 25-year-old man who has received a transplant of the left kidney is exhibiting symptoms that suggest hyperacute rejection of the transplant. What is the probable time frame for this type of rejection to occur?