Archives: Medical Student Finals

MSFinals-1421

A 63-year-old man presents to the Emergency Department with vague, crampy central abdominal ‘discomfort’ for the last three days. He was recently prescribed codeine phosphate for knee pain, which is secondary to osteoarthritis. He has never had this type of abdominal discomfort before. He last moved his bowels three days ago but denies nausea and vomiting. His past medical history is significant for hypertension. He has a 40-pack-year smoking history and denies any history of alcohol use. He has had no previous surgery.
His physical examination is normal. His observations and blood test results are shown below.
Temperature 36.3°C
Blood pressure 145/88 mmHg
Respiratory rate 15 breaths/min
Oxygen saturation (SpO2) 99% (room air)
Investigation Result Normal value
White cell count (WCC) 5.5 × 109/l 4–11 × 109/l
C-reactive protein (CRP) 1.5 mg/dl 0–10 mg/l
Total bilirubin 5.0 µmol/l 2–17 µmol/l
The Emergency doctor performs an abdominal ultrasound to examine for an abdominal aortic aneurysm. During this process, he also performs an ultrasound scan of the right upper quadrant, which shows several gallstones in a thin-walled gallbladder. The abdominal aorta is visualised and has a diameter of 2.3 cm. The patient’s abdominal pain is thought to be due to constipation.
Which of the following is the most appropriate management for this patient’s gallstones?

MSFinals-1422

A 50-year-old man patient who has a history of type 2 diabetes mellitus presents to his general practitioner with complaints of white lesions in his mouth.
On examination, the white lesions inside the patient’s mouth can easily be scraped off with minimal bleeding. The patient does not have cervical lymph node enlargement and is otherwise well.
Which of the following options is the most appropriate step in the management of this patient?

MSFinals-1423

A 50-year-old woman visits her General Practitioner (GP) complaining of a painful sore inside her mouth that has been bothering her for the past week. The patient has a medical history of type 2 diabetes mellitus and takes metformin for it.

During the mouth examination, the GP observes an oval-shaped, shallow ulcer with a red rim around it. The ulcer is sensitive to touch, and no other lesions are visible. The patient does not have swollen lymph nodes and is in good health otherwise.

What is the most appropriate course of action for managing this patient’s condition?

MSFinals-1424

A 32-year-old woman who was diagnosed with ulcerative colitis (UC) five years ago is seeking advice on the frequency of colonoscopy in UC. Her UC is currently under control, and she has no family history of malignancy. She had a routine colonoscopy about 18 months ago. When should she schedule her next colonoscopy appointment?

MSFinals-1425

A 59-year-old librarian is brought to the Emergency Department after experiencing haematemesis. The patient has been complaining of epigastric discomfort for the past few weeks and has been self-medicating with over-the-counter antacids. This morning, the patient continued to experience the discomfort and suddenly vomited about a cup of fresh blood. The patient is a non-smoker but consumes approximately 15 units of alcohol per week. He is currently taking atorvastatin for high cholesterol but has no other significant medical history. Upon further questioning, the patient reveals that he takes 75 mg aspirin daily, as he once read in the newspaper that it would be beneficial for his long-term cardiac health. What is the mechanism by which aspirin damages the gastric mucosa?

MSFinals-1426

A 55-year-old man, who has been a heavy drinker for many years, arrives at the Emergency Department with intense abdominal pain. During the abdominal examination, caput medusae is observed. Which vessels combine to form the obstructed blood vessel in this patient?

MSFinals-1427

A 26-year-old man has recently been diagnosed with ulcerative colitis. Investigation has revealed that he has distal disease only. He has a moderate exacerbation of his disease with an average of 4–5 episodes of bloody diarrhoea per day. There is no anaemia. His pulse rate is 80 bpm. He has no fever. His erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are normal.
Which is the most appropriate medication to use in the first instance in this exacerbation?

MSFinals-1428

A 40-year-old man presents to the Emergency Department with bloody bowel motions and abdominal cramping for the last eight hours. He is also complaining of fatigue.
He has a past medical history significant for Crohn’s disease, but is non-compliant with azathioprine as it gives him severe nausea. He takes no other regular medications. He has no drug allergies and does not smoke or drink alcohol.
Physical examination reveals diffuse abdominal pain, without abdominal rigidity.
His observations are as follows:
Temperature 37.5 °C
Blood pressure 105/88 mmHg
Heart rate 105 bpm
Respiratory rate 20 breaths/min
Oxygen saturation (SpO2) 99% (room air)
His blood tests results are shown below:
Investigation Result Normal value
White cell count (WCC) 14.5 × 109/l 4–11 × 109/l
C-reactive protein (CRP) 51.2 mg/l 0–10 mg/l
Haemoglobin 139 g/l 135–175 g/l
Which of the following is the most appropriate management for this patient?

MSFinals-1429

A 28-year-old woman reports difficulty swallowing both solids and liquids, with occasional food getting stuck and needing to be washed down with a large drink. Achalasia of the oesophagus is suspected. Which nerve supplies the muscularis externa of the oesophagus?

MSFinals-1430

You are the Foundation Year doctor on the Gastroenterology ward round. The consultant is reviewing a new patient to the ward. This is a 32-year-old man with active Crohn’s disease. From the medical notes, you are aware that the patient has had a number of previous admissions to the Unit and poor response to conventional therapy. The consultant mentions the possibility of using a drug called infliximab, and the patient asks whether this is an antibiotic.
What is the mode of action of infliximab?