Archives: Medical Student Finals

MSFinals-1397

A 40-year-old woman has been visiting her doctor frequently over the past year due to recurring episodes of abdominal cramps and diarrhoea. She is concerned about the possibility of bowel cancer, as her father passed away from it at the age of 86. She has no other relevant family history. She also mentions that she needs a refill for her salbutamol inhaler, which she takes for her recently diagnosed asthma. Additionally, she has noticed an increase in hot flashes and wonders if she is experiencing early menopause. She has lost some weight, which she attributes to her healthy diet. What is the most probable diagnosis?

MSFinals-1398

A 50-year-old man presents to the Emergency Department with a 3-week history of tiredness, epigastric discomfort and an episode of passing black stools. His past medical history includes a 4-year history of rheumatoid arthritis for which he takes regular methotrexate, folic acid and naproxen. He recently received a course of oral corticosteroids for a flare of his rheumatoid arthritis. He denies alcohol consumption and is a non-smoker. On systemic enquiry he reports a good appetite and denies any weight loss. The examination reveals conjunctival pallor and a soft abdomen with tenderness in the epigastrium. His temperature is 36.7°C, blood pressure is 112/68 mmHg, pulse is 81 beats per minute and oxygen saturations are 96% on room air. A full blood count is taken which reveals the following:
Investigation Result Normal Value
Haemoglobin 76 g/l 135–175 g/l
Mean corpuscular volume (MCV) 68 fl 76–98 fl
White cell count (WCC) 5.2 × 109/l 4–11 × 109/l
Platelets 380 × 109/l 150–400 × 109/l
Which of the following is the most likely diagnosis?

MSFinals-1399

An FY1 doctor on the surgical assessment unit reviews the result of a blood test of one of the admitted elderly patients. It appears that the elderly patient has had an acute rise in his plasma urea levels.
In which of the following conditions would you expect a raised plasma urea level in an elderly patient?

MSFinals-1400

A 22-year-old man presents to the Student Health Service after a ‘flu like’ illness. He has noticed that his eyes have become yellow over the past two days and he has been off his food. On examination, there are no significant abnormal findings.
Investigations:
Investigation Result Normal value
Haemoglobin 140 g/l 135–175 g/l
White cell count (WCC) 6.4 × 109/l 4–11 × 109/l
Platelets 230 × 109/l 150–400 × 109/l
Sodium (Na+) 139 mmol/l 135–145 mmol/l
Potassium (K+) 4.9 mmol/l 3.5–5.0 mmol/l
Creatinine 80 μmol/l 50–120 µmol/l
Alanine aminotransferase (ALT) 25 IU/l 5–30 IU/l
Bilirubin 67 μmol/l 2–17 µmol/l
Lactate Dehydrogenase (LDH) 105 IU/l 100–190 IU/l
Urine bile salts +
Hepatic ultrasound scan – Normal
Which of the following is the most likely diagnosis?

MSFinals-1371

A 25-year-old medical student is worried that she might have coeliac disease after learning about it during her gastroenterology rotation. She schedules an appointment with her GP to address her concerns, and the GP orders routine blood tests and coeliac serology as the initial investigation. What is the most frequently linked condition to coeliac disease?

MSFinals-1372

A 65-year-old woman presents with abdominal pain that occurs after eating. She also reports weight loss due to her abdominal pain preventing her from eating large amounts. Her medical history includes stable angina and intermittent claudication caused by peripheral arterial disease. Upon examination, there are no visible abnormalities on the abdomen, but there is general tenderness upon palpation, no signs of organ enlargement, and normal bowel sounds. Routine blood tests, including full blood count, urea and electrolytes, and liver function tests, are normal. CT angiography shows an obstructed coeliac trunk and a stenosed but patent superior mesenteric artery. Which organ is most likely to be ischemic and contributing to this patient’s symptoms?

MSFinals-1373

A 36-year-old man presents with abnormal liver function tests. He has no history of alcohol consumption and no known risk factors for liver disease. However, his grandfather passed away from liver cancer. Upon investigation, his serum albumin is 38 g/L (37-49), serum total bilirubin is 41 μmol/L (1-22), serum alanine aminotransferase is 105 U/L (5-35), serum alkaline phosphatase is 135 U/L (45-105), serum ferritin is 1360 mcg/L, and serum iron saturation is 84%. A liver biopsy reveals Perls’ Prussian blue positive deposits in the liver. What is the most appropriate first-line treatment?

MSFinals-1374

A 14-year-old girl with cystic fibrosis complains of abdominal pain. She denies any accompanying nausea or vomiting. What is the most probable cause of her symptoms?

MSFinals-1375

A 76-year-old woman comes to the Emergency Department complaining of worsening epigastric pain over the past two weeks. She describes a deep pain in the central part of her abdomen that tends to improve after eating and worsens approximately two hours after the meal. The pain does not radiate. The patient has a medical history of rheumatoid arthritis and takes methotrexate and anti-inflammatory medications. She is also a heavy smoker. Her vital signs are within normal limits. On examination, there is tenderness in the epigastric region without guarding or rigidity. Bowel sounds are present. What is the most likely diagnosis for this patient?

MSFinals-1376

You are working at a General Practice surgery, and a 30-year-old office worker presents with abdominal discomfort and frequent episodes of diarrhoea with blood and mucous mixed in. He reports feeling as though he needs to empty his bowels, even after he has just done so. Symptoms have worsened over the past 2 months. He has no nausea or vomiting and has not been abroad in the last year. He has not lost weight. His only recent medications are paracetamol and loperamide. On examination, his abdomen is soft, but there is mild tenderness in the left lower quadrant. There is blood on the glove after digital rectal examination.
Which of the following is the most likely diagnosis?