Archives: Medical Student Finals

MSFinals-1512

A 24-year-old waitress who works at a restaurant in Spain has returned home to see her doctor because she is feeling unwell. She has been experiencing increasing nausea and fatigue and noticed that her urine had darkened a few days ago, and now her stools are pale. Additionally, she has been suffering from severe itching. During the examination, she was found to be jaundiced with scratch marks on her skin and a temperature of 38.1°C.

The following investigations were conducted:

– Haemoglobin: 120 g/l (normal range: 115–155 g/l)
– White cell count (WCC): 11.1 × 109/l (normal range: 4–11 × 109/l)
– Platelets: 170 × 109/l (normal range: 150–400 × 109/l)
– Prothrombin Test (PT): 17.1 s (normal range: 10.6–14.9 s)
– Erythrocyte sedimentation rate (ESR): 48 mm/hr (normal range: 0–10mm in the 1st hour)
– Alanine aminotransferase (ALT): 795 IU/l (normal range: 5–30 IU/l)
– Bilirubin: 100 μmol/l (normal range: 2–17 µmol/l)
– Alkaline phosphatase: 90 IU/l (normal range: 30–130 IU/l)
– Anti hepatitis A IgM markedly elevated

What is the most accurate prognosis for this 24-year-old waitress?

MSFinals-1514

A 70-year-old man comes to Surgical Outpatients, reporting abdominal pain after eating. He has a medical history of a heart attack and three transient ischaemic attacks (TIAs). The doctor diagnoses him with chronic mesenteric ischaemia. What section of the intestine is typically affected?

MSFinals-1515

A 45-year-old man who lives in a local hostel for the homeless is added onto the medical take following a seizure. He last consumed alcohol 32 h previously and, when assessed, he is tremulous and anxious, wishing to self-discharge. His nutritional status and personal hygiene are poor.
Which one of the following is the most essential to be carefully monitored while an inpatient?

MSFinals-1516

A 50-year-old man presents to his gastroenterologist with complaints of recurrent diarrhoea, sweating episodes, and intermittent shortness of breath. During physical examination, a murmur is detected in the pulmonary valve. Urine testing reveals a high level of 5-hydroxyindoleacetic acid content. What substance is likely responsible for these findings?

MSFinals-1517

A 45-year-old man with dyspepsia and a history of recurrent peptic ulcer disease presents with intractable watery diarrhoea and weight loss. He has multiple gastric and duodenal peptic ulcers, which are poorly responding to medications such as antacids and omeprazole. Gastric acid output and serum gastrin level are elevated. Serum gastrin level fails to decrease following a test meal. On abdominal computerised tomography (CT) scan, no masses are found in the pancreas or duodenum.
Which one of the following drugs is useful for this patient?

MSFinals-1518

A 50-year-old woman presents with difficult-to-manage diabetes mellitus. She was diagnosed with gallstones a year earlier. She also complains of steatorrhoea and diarrhoea. There has been some weight loss over the past 6 months.
Investigations:
Investigation Result Normal value
Haemoglobin 119 g/l 115–155 g/l
White cell count (WCC) 4.7 × 109/l 4–11 × 109/l
Platelets 179 × 109/l 150–400 × 109/l
Sodium (Na+) 139 mmol/l 135–145 mmol/l
Potassium (K+) 4.7 mmol/l 3.5–5.0 mmol/l
Creatinine 120 μmol/l 50–120 µmol/l
Glucose 9.8 mmol/l 3.5–5.5 mmol/l
Somatostatin 105 pg/ml 10–22 pg/ml
T1-weighted gadolinium-enhanced magnetic resonance imaging (MRI): 4-cm pancreatic tumour
Which of the following is the most likely diagnosis?

MSFinals-1519

A 38-year-old man with cirrhosis of the liver and ascites presented with clinical deterioration. Diagnostic aspiration of the ascites fluid shows a raised neutrophil count in the ascites fluid.
Which of the following statements best fits this scenario?

MSFinals-1520

A 31-year-old man comes to the clinic complaining of progressive weakness and fatigue. He reports experiencing ‘abdominal complaints’ for the past 6 years, without relief from any treatments. Upon examination, he appears severely pale and has glossitis. He has been having bowel movements five to six times per day. The only significant history he has is that he had to undergo surgery at the age of 4 to remove a swallowed toy. Blood tests show the following results: Hemoglobin – 98 g/l (normal range: 135-175 g/l), Vitamin B12 – 60 pmol/l (normal range: 160-900 pmol/l), Folate – 51 μg/l (normal range: 2.0-11.0 μg/l), and Cholesterol – 2.7 mmol/l (normal range: <5.2 mmol/l). What is the appropriate definitive treatment for this condition?

MSFinals-1521

A 28-year-old man, diagnosed with ulcerative colitis (UC) 18 months ago, presents with 2-day history of progressively worsening abdominal pain and bloody diarrhoea. He is currently passing motion 11 times per day.
On examination, there is generalised abdominal tenderness and distension. He is pyrexial, with a temperature of 39 °C; his pulse is 124 bpm.
Investigations:
Investigation Result Normal value
Haemoglobin (Hb) 90 g/l 135–175 g/l
White cell count (WCC) 15 × 109/l 4–11 × 109/l
Erect chest X-ray Normal
Plain abdominal X-ray 12-cm dilation of the transverse colon
He also has a raised C-reactive protein (CRP).
What would be the most appropriate initial management of this patient?