Archives: Medical Student Finals

MSFinals-1387

A 31-year-old man is urgently referred to the Medical Admission Unit by his general practitioner due to a 2-week history of worsening diarrhoea that has become bloody over the past few days. He has no recent history of foreign travel and no significant medical history. Over the last 48 hours, he has been experiencing bowel movements approximately 10 times a day. Upon examination, he appears dehydrated, and his abdomen is diffusely tender to palpation with active bowel sounds. There is no rebound tenderness or guarding. Initial investigations have been requested, including FBC, U&Es, liver function tests, and C-reactive protein. Stool has been sent for microscopy, and Clostridium difficile toxin testing has been requested. What is the most appropriate next step in the investigation?

MSFinals-1388

A 55-year-old woman presents with acute abdominal pain and a temperature of 38.5 °C, pulse 130 bpm and blood pressure 100/70 mmHg. She does not allow any attending doctor to touch her abdomen, as she is in severe pain.
Past records reveal that she was suffering from ulcerative colitis, for which she was on oral mesalazine and azathioprine. She has recently had diarrhoea for which she has taken loperamide.
What is the next appropriate diagnostic test?

MSFinals-1389

A 55-year-old man, with a history of moderate alcohol intake (20 units/week), presents with complaints of arthralgia and worsening erectile dysfunction over the past 6–9 months. On examination, he has a deep tan and evidence of chronic liver disease. The following investigations were conducted:

Investigation Result Normal value
Haemoglobin 145 g/l 135–175 g/l
White Cell Count 8.3 x 109/l 4–11 x 109/l
Platelets 164 x 109/l 150–400 x 109/l
Urea 6.0 mmol/l 2.5–6.5 mmol/l
Sodium 140 mmol/l 135–145 mmol/l
Potassium 4.2 mmol/l 3.5–5.0 mmol/l
Creatinine 95 μmol/l 50–120 µmol/l
Aspartate Aminotransferase (AST) 65 IU/l 10–40 IU/l
Alanine Aminotransferase (ALT) 82 IU/l 5–30 IU/l
Alkaline Phosphatase 135 IU/l 30–130 IU/l
Bilirubin 23 mmol/l 2–17 µmol/l
Lactate dehydrogenase (LDH) 326 IU/l 100–190 IU/l
Serum iron 45 μmol/l 0.74–30.43 μmol/l
Total iron-binding capacity 6.2 μmol/l 10.74–30.43 μmol/l
Ferritin 623 μg/ 20–250 µg/l
Glucose 8.8 mmol/l <7.0 mmol/l What is the most likely diagnosis?

MSFinals-1390

A 50-year-old man who has recently had a gastrectomy is informed that he will experience a deficiency in vitamin B12. What is the probable physiological reasoning behind this?

MSFinals-1351

A 68-year-old man presented with fatigue and difficulty breathing. Upon examination, he appeared pale and blood tests showed a hemoglobin level of 62 g/l and a mean corpuscular volume (MCV) of 64 fl. Although he did not exhibit any signs of bleeding, his stool occult blood test (OBT) was positive twice. Despite undergoing upper GI endoscopy, colonoscopy, and small bowel contrast study, all results were reported as normal. What would be the most appropriate next step in investigating this patient?

MSFinals-1352

A 70-year-old man presents to his general practitioner (GP) with complaints of difficulty swallowing. He mentions that solid food like meat often gets stuck in his throat. He is also beginning to lose weight and have difficulty swallowing thick liquids like soups. There is some pain on swallowing. His past medical history is significant for hypertension and depression. His current medications include amlodipine and sertraline. He has no drug allergies. He has a 30-pack-year history of smoking and drinks approximately 3–4 pints of beer per day. He is unsure of his family medical history, as he was adopted.
Physical examination is normal, and his observations are shown below:
Temperature 37.1°C
Blood pressure 145/81 mmHg
Heart rate 71 bpm
Respiratory rate 14 breaths/min
Oxygen saturation (SpO2) 97% (room air)
Which of the following is the most appropriate investigation for this patient?

MSFinals-1353

A middle aged male patient presents with jaundice and epigastric abdominal pain, he describes an intermittent history of similar pain over the past 3 months, however, this time it is much worse. He has markedly raised bilirubin and mildly deranged LFTs, with a predominantly obstructive picture. Other pertinent history includes mild alcohol use.
What is the most likely cause for his symptoms?

MSFinals-1354

A 21-year-old student presents to the University Health Service with jaundice. He had been to a party three nights earlier and since then has been laid up in bed with flu-like symptoms. On examination, he has mild jaundice, but otherwise the examination is normal.
Bloods:
Investigation Result Normal value
Bilirubin 62 μmol/l 2–17 µmol/l
Alanine aminotransferase (ALT) 21 IU/l 5–30 IU/l
Aspartate aminotransferase (AST) 15 IU/l 10–40 IU/l
Haemoglobin 131 g/l 135–175 g/l
White cell count (WCC) 4.2 × 109/l 4–11 × 109/l
Platelets 320 × 109/l 150–400 × 109/l
Which of the following is the most likely diagnosis in this case?

MSFinals-1355

A patient presents with jaundice. The following results are available:
HBsAg +ve, HBeAg +ve, HBeAb −ve, HBc IgM +ve
Which one of the following interpretations is correct for a patient who is slightly older?

MSFinals-1356

A 55-year-old obese woman, who recently returned from a trip to Japan, presents with chronic diarrhoea, fatigue, and greasy, bulky stools. She is a non-smoker and non-drinker who consumes meat. Stool examination confirms steatorrhoea, and blood tests reveal elevated folic acid levels and reduced vitamin B12 levels. The only abnormal finding on a CT scan of the abdomen is multiple diverticula in the jejunum. What is the most likely cause of this patient’s macrocytic anaemia?