Archives: Medical Student Finals

MSFinals-6329

A 72-year-old male is brought to the emergency department by his daughter. His daughter reports that 3 days ago, he fell down the stairs and hit his head. Initially, he seemed fine and did not want to go to the hospital. However, his daughter is now concerned as he has been acting confused on and off, which is unusual for him.

The patient has a medical history of atrial fibrillation, which is managed with warfarin. He also has well-controlled high blood pressure and diabetes. He does not consume alcohol.

The patient is unresponsive and unable to provide a history. During the neurological examination, there is no weakness in the face or limbs.

What is the most likely diagnosis based on this information?

MSFinals-6330

A 38-year-old woman comes to her GP complaining of breast discharge. The discharge is only from her right breast and is blood-tinged. The patient reports feeling fine and has no other symptoms. During the examination, both breasts appear normal without skin changes. However, a tender and fixed lump is palpable under the right nipple. No additional masses are found upon palpation of the axillae and tails of Spence. What is the probable diagnosis?

MSFinals-6331

A 68-year-old male with a history of atrial fibrillation presents with sudden abdominal pain. The pain started after he had fried chicken for lunch. Upon examination, his temperature is 38.7ºC, pulse 120/min, respiratory rate 30/min, blood pressure 87/72 mmHg, and his abdomen is tender with generalised guarding. Blood tests reveal abnormal levels of Na+, K+, urea, creatinine, bicarbonate, and lactate. What is the most likely diagnosis, and what would be the most appropriate definitive treatment?

MSFinals-6332

A 75-year-old man presents to the emergency department with a 2-day history of lower abdominal pain and rectal bleeding. He reports that over the past 2-3 months he has had bouts of intermittent lower abdominal pain. He usually opens his bowels once every 4-5 days and complains of passing hard stools. There is no past medical history of note.

Upon examination, he has a temperature of 38.1ºC with a heart rate of 80 beats/min and a blood pressure of 122/85 mmHg. There is palpable tenderness with guarding in the left iliac fossa.

What is the most appropriate long-term management plan for this patient?

MSFinals-6333

A 68-year-old man is undergoing investigation for iron deficiency anaemia. He has no notable symptoms except for mild hypertension. An outpatient CT scan of his abdomen and pelvis reveals no cause for anaemia but incidentally discovers an abnormal dilation of the abdominal aorta measuring 4.4 cm in diameter. The patient reports having undergone an ultrasound scan of his abdomen 6 months ago as part of the national AAA screening program, which showed a dilation of 3 cm in diameter. What is the best course of action for management?

MSFinals-6334

A 25-year-old woman presents to the emergency department complaining of right-sided back pain and dysuria that has been bothering her for the past two days. The pain is constant and severe, and it radiates from her renal angle to her groin. Upon examination, her temperature is 38.1ºC, her heart rate is 101 bpm, her blood pressure is 139/91 mmHg, and she has a tender renal angle with a palpable mass on the right side of her abdomen. What is the most appropriate investigation to evaluate her abdominal mass?

MSFinals-6335

A 28-year-old presents to the Emergency Department with suspected renal colic. An ultrasound reveals a possible stone in the right ureter. What would be the most suitable course of action for imaging?

MSFinals-6313

A 65-year-old woman visits her GP complaining of a lump in her groin area that she noticed last week. The lump is painless. During the examination, a soft, non-tender mass is palpable on her left inguinal area, medial and superior to the pubic tubercle. The lump disappears when she lies down, but when you try to reduce it and press on the mid-point of the inguinal ligament, it still protrudes if the patient stands up. The patient has no medical history and is not taking any medication. What is the most likely diagnosis?

MSFinals-6314

A 25-year-old man has had surgery for an inguinal hernia. After a week, he comes back with a wound that is red, painful, and oozing pus. What is the probable reason for this?

MSFinals-6315

A 65-year-old woman presents with severe colicky central abdominal pain, vomiting, and the passage of abnormal stool which had the appearance of redcurrant jelly.

On examination, temperature was 37.5°C, she has a pulse of 120 bpm with an irregular rate. Palpation of the abdomen revealed generalised tenderness and peritonitis.

Investigations reveal:

Haemoglobin 128 g/L (120-160)

White cell count 30 ×109/L (4-11)

Lactate 9 mmol/L (<2) pH 7.10 (7.36-7.44) She was taken to theatre for emergency surgery. What is the likely diagnosis?