Archives: Medical Student Finals

MSFinals-1465

A 39-year-old man presents to Accident and Emergency with sudden onset vomiting and severe upper abdominal pain. On examination, he appears unwell, with a high heart and respiratory rate, and a temperature of 38.0°C. His blood pressure is 112/74 mmHg. He localises the pain to his upper abdomen, with some radiation to the back. His abdomen is generally tender, with bowel sounds present. There is no blood in his vomit. He is unable to provide further history due to the pain and nausea, but he is known to Accident and Emergency due to many previous admissions with alcohol intoxication. He has previously been normotensive, is a non-smoker and has not been treated for any other conditions.
Based on the information provided, what is the most likely diagnosis?

MSFinals-1466

A 47-year-old man presents to the Hepatology Clinic with mild elevations in levels of alkaline phosphatase (ALP) and aminotransferases. He has a history of type 2 diabetes mellitus and obesity, but denies alcohol use and past drug use. On physical examination, he is found to be obese with hepatomegaly. Laboratory studies show negative results for hepatitis and autoimmune liver disease. His aminotransferase, ALP, and autoimmune liver results are provided. What is the most appropriate treatment for this patient?

MSFinals-1467

A 38-year-old man presents to the clinic after an insurance medical. He was noted to have an abnormal alanine aminotransferase (ALT). Past history includes obesity, hypertension and hypercholesterolaemia, which he manages with diet control. He denies any significant alcohol intake. He has a body mass index (BMI) of 31.
Investigations:
Investigation Result Normal value
Haemoglobin 139 g/l 135–175 g/l
White cell count (WCC) 4.1 × 109/l 4–11 × 109/l
Platelets 394 × 109/l 150–400 × 109/l
Sodium (Na+) 143 mmo/l 135–145 mmol/l
Potassium (K+) 4.9 mmol/l 3.5–5.0 mmol/l
Creatinine 85 μmol/l 50–120 µmol/l
Alanine aminotransferase (ALT) 150 IU/l 5–30 IU/l
Alkaline phosphatase 95 IU/l 30–130 IU/l
Bilirubin 28 μmol/l 2–17 µmol/l
Total cholesterol 6.8 mmol/l < 5.2 mmol/l
Triglycerides 3.8 mmol/l 0–1.5 mmol/l
Ultrasound of liver Increase in echogenicity
Which of the following is the most likely diagnosis?

MSFinals-1468

A 67-year-old man presents with nausea, vomiting, epigastric discomfort and weight loss over the last 2 months. On questioning, he describes postprandial fullness and loss of appetite. He denies any dysphagia, melaena or haematemesis. He has a long-standing history of heartburn. He has no other relevant past medical history. Investigations reveal iron deficiency anaemia. Endoscopy confirms gastric cancer.
What is a risk factor for gastric cancer in this 67-year-old man?

MSFinals-1432

A 58-year-old woman presents to the Emergency Department with abdominal pain, fever and two episodes of vomiting. She states that she has had previous episodes of right upper-quadrant pain with radiation to the right shoulder blade but has never sought medical attention for this.
Her past medical history is significant for obesity and hypertension.
Examination reveals an obese abdomen with tenderness in the right upper quadrant and epigastric region. No jaundice is evident.
Observations are as follows:
Temperature 38.5°C
Heart rate 87 beats per minute
Respiratory rate 19 breaths per minute
SpO2 98% (room air)
Blood pressure 145/86 mmHg
Laboratory results reveal an elevated white cell count and C-reactive protein. An abdominal ultrasound reveals multiple gallstones in the body of the gallbladder. The gallbladder is thickened, with the largest stone measuring 17 mm.
Which of the following is the most appropriate next step in management?

MSFinals-1433

A 49-year-old woman visits her GP complaining of fatigue and wondering if she has entered menopause. Upon conducting a blood test, the results show a Hb of 101 g/l, MCV 108.2 fl, and a B12 level of 46 ng/l. She also reports experiencing occasional changes in bowel movements. What test would be most effective in differentiating pernicious anemia from other malabsorption causes as the reason for her low B12 levels?

MSFinals-1434

A 50-year-old man presents to the Acute Medical Unit with complaints of mucous and bloody diarrhoea. He has experienced milder episodes intermittently over the past five years but has never sought medical attention. The patient reports left lower abdominal pain and occasional right hip pain. On examination, there is tenderness in the lower left abdominal region without radiation. The patient has not traveled outside the UK and has not been in contact with anyone with similar symptoms. There is no significant family history. What is the most probable diagnosis?

MSFinals-1435

A 28-year-old woman presented to her General Practitioner complaining of six months of intermittent uncomfortable abdominal distension and bloating, which changed with her menstrual cycle. These symptoms were interspersed with bouts of loose motions. She worked as a teacher in a busy school and found work very stressful; she had previously taken a course of sertraline for anxiety and depression. Examination, blood test results and sigmoidoscopy were all normal.
What is the most likely diagnosis?

MSFinals-1436

A 16-year-old previously healthy woman presents with a 10-month history of persistent non-bloody diarrhoea and central abdominal pain. She also gives a history of unintentional weight loss. The patient is not yet menstruating. On examination, she has slight conjunctival pallor. Blood tests reveal a macrocytic anaemia.
What is the likeliest diagnosis?

MSFinals-1437

A 11-month-old boy is admitted to hospital with an episode of rectal bleeding – the mother noticed that the child had been difficult to settle in the day, on changing the child’s nappy she noted a substance which looked like redcurrant jelly in the nappy contents. A diagnosis of Meckel’s diverticulum is suspected.
With regard to Meckel’s diverticulum, which one of the following statements is correct?