Archives: Medical Student Finals

MSFinals-1439

A 55-year-old man presents with epigastric pain which radiates to the back. He feels nauseous and has been vomiting since arriving at the Emergency Department (ED). On questioning, the man tells you that he takes no regular medication. He was last in hospital three years ago after he fell from his bicycle when cycling under the influence of alcohol. He was not admitted. He travelled to Nigeria to visit relatives three months ago.
On examination, the man’s abdomen is tender in the epigastrium. He is jaundiced. He is also tachycardic and pyrexial. Some of his investigation results are as follows:
Investigation Result Normal value
Alkaline phosphatase (ALP) 320 IU/l 30–130 IU/l
Alanine aminotransferase (ALT) 70 IU/l 5–30 IU/l
Bilirubin 45 µmol/l 2–17 µmol/l
What is the best initial treatment for this man?

MSFinals-1440

A 33-year-old university teacher returned to the United Kingdom after spending 2 years in India on a spiritual journey. During his time there, he stayed in various ashrams and ate local food with the local disciples. Unfortunately, he contracted malaria twice, suffered from diarrhoea once, and had a urinary tract infection. Upon returning to the UK, he complained of chronic diarrhoea and abdominal pain, which worsened after consuming milk. Blood tests showed a low haemoglobin level of 92 g/l (normal range: 135-175 g/l), a high mean corpuscular volume (MCV) of 109 fl (normal range: 76-98 fl), and a white cell count (WCC) of 8 × 109/l (normal range: 4-11 × 109/l). Stool samples and blood tests for IgA Ttg and HIV antibodies were negative. What test would be most helpful in diagnosing this patient?

MSFinals-1441

A 52-year-old woman presents with persistent generalized itching and yellowing of the skin for the past 4 weeks. The symptoms have been gradually worsening. She has no significant medical history and is postmenopausal. She lives with her husband and has a monogamous sexual relationship. Vital signs are normal, but her skin and sclera are yellowish. There is mild enlargement of the liver and spleen. Her serum alanine aminotransferase (ALT) level is 250 iu/l, aspartate transaminase (AST) level 320 iu/l, alkaline phosphatase level 2500 iu/l, γ-glutamyl transpeptidase level 125 iu/l, total bilirubin level 51.3 μmol/l and direct bilirubin level 35.9 μmol/l. Hepatitis B and C serologic tests are negative, but her serum titre of anti-mitochondrial antibody is elevated. What medication would be most effective for long-term treatment of this patient?

MSFinals-1442

A 45-year-old man has been experiencing burning epigastric pain and vomiting on and off for the past 4 weeks. His father was recently treated for gastric cancer. During an upper GI endoscopy, gastric biopsies were taken and tested positive for Helicobacter pylori. The patient has a penicillin allergy. What is the most suitable initial treatment for eradicating H. pylori in this individual?

MSFinals-1443

A 35-year-old man presents to his primary care doctor, complaining of difficulty swallowing solid foods and liquids for the last two months. He states that food often ‘gets stuck’ in his oesophagus and is associated with retrosternal chest pain. There is no pain on swallowing. He has no other medical problems and takes no medications. He denies recent weight loss or night sweats.
Physical examination is normal. An electrocardiogram (ECG) reveals normal sinus rhythm, without ischaemic changes. His blood tests are also normal. A diagnosis of diffuse oesophageal spasm is being considered.
Which of the following is the most appropriate investigation for this patient?

MSFinals-1444

A 50-year-old man presents with painless bleeding per rectum for two days. The blood was mixed with stool every time. There was no pain or tenesmus. There has been no loss of weight.

He has never experienced these symptoms before, although he has suffered from constipation over the past three years. At the clinic, he complained of mild fever, although on examination, his temperature was normal.

He has recently returned from a trip to India where he took part in a mountain expedition to Kedarnath. He takes no drugs, with the exception of thyroxine which he has taken for the past two years.

What is the immediate management?

MSFinals-1445

A 75-year-old widower comes to the Emergency Department following a mechanical fall at a nearby store. His orthopaedic examination is normal, but he is extremely thin and agitated, has halitosis and gingivitis, and perifollicular hemorrhages are visible.
What is the most probable diagnosis?

MSFinals-1446

A 40-year-old man returns from a trip to Thailand and experiences fatigue, malaise, loss of appetite, and jaundice. He has no significant medical history and denies excessive alcohol consumption. Upon investigation, his serum total bilirubin is 71 μmol/L (1-22), serum alanine aminotransferase is 195 U/L (5-35), and serum alkaline phosphatase is 100 U/L (45-105). His serum IgM antihepatitis A is negative, but serum IgG antihepatitis A is positive. Additionally, his serum hepatitis B surface antigen (HBsAg) is positive, but serum antibody to hepatitis C is negative. What is the most likely diagnosis?

MSFinals-1447

A 70-year-old man presents with a history of intermittent constipation and diarrhoea and progressive weight loss over the past 3 months. During examination, he appears cachectic and has nodular hepatomegaly. He does not exhibit jaundice and his liver function tests are normal.
What is the most probable diagnosis?