Archives: Medical Student Finals

MSFinals-1537

Olivia is a 15-year-old girl presenting with abdominal pains. The abdominal pain was around her lower abdomen and is crampy in nature and occasionally radiates to her back. Her pain normally comes on approximately before the onset of her period. She also feels increasingly fatigued during this period. No abdominal pains were noted outside of this menstrual  period.

Olivia has no significant medical history. She denies any recent changes in her diet or bowel habits. She has not experienced any recent weight loss or rectal bleeding. She denies any family history of inflammatory bowel disease or colon cancer.

Given the likely diagnosis, what is the likely 1st line treatment?

MSFinals-1538

A 50-year-old woman comes to see her GP complaining of persistent abdominal cramping, bloating, and diarrhoea that has been going on for 5 months. She reports no blood in her stools, no unexplained weight loss, and no fatigue. Her medical history includes obesity, but there is no family history of any relevant conditions.

Upon examination, her heart rate is 80 bpm, her blood pressure is 130/75 mmHg, and she has no fever. Both her abdominal and pelvic exams are unremarkable, and there is no pallor or jaundice.

What is the most appropriate next step in managing this patient’s symptoms?

MSFinals-1539

A 67-year-old woman comes to her GP complaining of abdominal discomfort and bloating that has persisted for six months. The GP initially suspected bowel cancer and referred her for a colonoscopy, which came back negative. The gastroenterologist who performed the colonoscopy suggested that the patient may have irritable bowel syndrome. The patient has no prior history of digestive issues. What should the GP do next?

MSFinals-1505

A 31-year-old woman presents to your Surgical Clinic referred by her General Practitioner (GP) with complaints of heartburn and indigestion that have been worsening at night. She denies any other gastrointestinal (GI) symptoms. She has a normal diet but smokes 20 cigarettes a day. On examination, you note that she is a large woman with a body mass index (BMI) of 37. Abdominal examination is unremarkable. An endoscopy is ordered, and the report is as follows:
Endoscopy – oesophagogastroduodenoscopy (OGD)
The OGD was performed with xylocaine throat spray, and intubation was uncomplicated. The oesophagus appears normal. A 5-cm hiatus hernia is observed and confirmed on J-manoeuvre. The stomach and duodenum up to D2 appear to be normal. CLO test was negative. Z-line at 45 cm.
What would be your next best step in managing this patient?

MSFinals-1506

A 56-year-old woman presents to her General Practitioner (GP) after experiencing ‘indigestion’ for the past six months. She has been using over-the-counter treatments without relief. She reports a burning-type sensation in her epigastric region which is present most of the time. Over the past four months, she has lost approximately 4 kg in weight. She denies dysphagia, melaena, nausea, or vomiting.
Upon examination, her abdomen is soft and non-tender without palpable masses.
What is the next step in managing her symptoms?

MSFinals-1507

A 45-year-old man with a history of intravenous (iv) drug abuse 16 years ago is referred by his doctor with abnormal liver function tests. He has significantly raised alanine aminotransferase (ALT). He tests positive for hepatitis C RNA and genotyping reveals genotype 1 hepatitis C. Liver biopsy reveals lymphocytic infiltration with some evidence of early hepatic fibrosis with associated necrosis.
Which of the following is the most appropriate therapy for this man?

MSFinals-1508

A 25-year-old male patient reports experiencing mild jaundice following periods of fasting or exercise. Upon examination, his complete blood count and liver function tests appear normal. What is the recommended course of treatment for this individual?

MSFinals-1509

A 70-year-old man presents to his GP with a complaint of difficulty swallowing that has been occurring for the past four weeks. He reports that solid foods are particularly problematic and feel as though they are getting stuck. The patient has a medical history of hypertension and osteoarthritis of the knees, for which he takes amlodipine 5 mg OD and paracetamol 1 g as required respectively. He has a 20-pack year smoking history but does not consume alcohol. On examination, the patient appears well at rest and has a normal body habitus. Abdominal examination is largely unremarkable, except for some mild epigastric discomfort. What is the most appropriate next step in management?

MSFinals-1510

A 30-year-old woman presents with intermittent, crampy abdominal pain over the past three months. She has noted frequent loose stools containing blood and mucous. She has also had a recent unintentional weight loss of 15 pounds. Past medical history of note includes treatment for a perianal fistula and anal fissures. The patient is investigated with imaging studies and endoscopy; histological examination of the intestinal biopsy specimens confirms a diagnosis of Crohn’s disease.
Antibodies to which of the following organisms is most likely to be found in this patient’s serum?

MSFinals-1511

A 32-year-old man presents with upper abdominal pain and is diagnosed with Helicobacter pylori infection. He is treated with appropriate eradication therapy and advised to follow up with his general practitioner for testing of eradication.
What would be the most suitable method for testing eradication in this patient?