Archives: Medical Student Finals

MSFinals-1495

A 59-year-old man presents to the Emergency Department with right upper quadrant pain, fever and chills for the last two days. His past medical history is significant for gallstone disease which has not been followed up for some time. He is febrile, but his other observations are normal.
Physical examination is remarkable for jaundice, scleral icterus and right upper-quadrant pain. There is no abdominal rigidity, and bowel sounds are present.
His blood test results are shown below.
Investigation Results Normal value
White cell count (WCC) 18.5 × 109/l 4–11 × 109/l
C-reactive protein (CRP) 97 mg/dl 0–10 mg/l
Bilirubin 40 µmol/l 2–17 µmol/l
Which of the following is the best next step in management?

MSFinals-1496

A 61-year-old man presents to the Emergency Department with acute-onset severe epigastric pain for the last eight hours. The pain radiates to the back and has been poorly controlled with paracetamol. The patient has not had this type of pain before. He also has associated nausea and five episodes of non-bloody, non-bilious vomiting. He last moved his bowels this morning. His past medical history is significant for alcoholism, epilepsy and depression, for which he is not compliant with treatment. The patient has been drinking approximately 25 pints of beer per week for the last 15 years. He has had no previous surgeries.
His observations and blood tests results are shown below. Examination reveals tenderness in the epigastrium, without rigidity.
Investigation Result Normal value
Temperature 37.0 °C
Blood pressure 151/81 mmHg
Heart rate 81 bpm
Respiratory rate 19 breaths/min
Oxygen saturation (SpO2) 99% (room air)
C-reactive protein 102 mg/l 0–10 mg/l
White cell count 18.5 × 109/l 4–11 × 109/l
Amylase 992 U/l < 200 U/l
Which of the following is the most likely diagnosis?

MSFinals-1497

A 32-year-old woman presents with a 15-month history of dysphagia. She has had difficulty with both liquids and solids from the onset. She reports no weight loss and there no past medical history of note. Investigation with a barium swallow demonstrates a dilated oesophagus with a ‘bird’s beak’ tapering of the distal oesophagus.
Which of the following is the most likely diagnosis?

MSFinals-1498

A 40-year-old woman complains of worsening intermittent dysphagia over the past year. She experiences severe retrosternal chest pain during these episodes and has more difficulty swallowing liquids than solids.
What is the most probable diagnosis?

MSFinals-1499

A 5-year old child has been admitted to the hospital after experiencing fever, feeling unwell, and developing bloody diarrhea for the past two days. What is the probable cause of these symptoms?

MSFinals-1500

A 43-year-old man presents with painless jaundice 2 months after returning from a trip to Thailand. He has no known history of liver disease. Laboratory results reveal bilirubin levels of 210 µmol/l, ALT levels of 1206 iu/l, ALP levels of 405 iu/l, PT of 10 s, and albumin levels of 41 g/dl. What is the most probable diagnosis?

MSFinals-1469

A 32-year-old, malnourished patient needs to have a nasogastric tube (NGT) inserted for enteral feeding. What is the most important measure to take before beginning the feeding plan?

MSFinals-1470

A 40-year-old woman presents with sudden onset of abdominal pain for the past 6 hours. The pain is rapidly worsening and is more severe in the right upper quadrant. She has no significant medical history and denies any recent illnesses or similar episodes in the past. She is sexually active and takes an oral contraceptive pill. Upon examination, her blood pressure is 120/80 mmHg, pulse rate 85 bpm, respiratory rate 16/min, and body temperature 37.5 ºC. The sclera is icteric. Tender hepatomegaly and shifting abdominal dullness are noted. Blood tests reveal elevated total and direct bilirubin, alanine aminotransferase, and aspartate aminotransferase. Partial thromboplastin time and prothrombin time are within normal limits. Mild to moderate abdominal ascites is found on an ultrasound study.
What is the most likely cause of her condition?

MSFinals-1471

A 50-year-old woman is referred to hospital for severe recurrent chest pain related to mealtimes. She had experienced these episodes over the past 3 years, particularly when food became stuck in her chest. The chest pain was not associated with physical activity or exertion. Additionally, she reported occasional nocturnal coughs and regurgitation. A chest X-ray taken during one of the chest pain episodes revealed a widened mediastinum. She did not have any other gastrointestinal issues or abdominal pain. Despite being prescribed proton pump inhibitors (PPIs), she did not experience any relief. What is the most effective test to confirm the diagnosis of the underlying condition?

MSFinals-1472

A 30-year-old male presents with massive haematemesis and is diagnosed with splenomegaly. What is the probable origin of the bleeding?