Archives: Medical Student Finals

MSFinals-1357

An 82-year-old man presents to his General Practitioner (GP) with a 4-month history of progressively worsening jaundice. His wife says that she noticed it a while ago, but her husband has been reluctant to come to see the GP. The man does not complain of any abdominal pain and on examination no masses are felt. He agrees when asked by the GP that he has lost quite some weight recently. The patient has a strong alcohol history and has been smoking 20 cigarettes daily since he was in his twenties. The GP refers the patient to secondary care.
Which one of the following is the most likely diagnosis for this patient?

MSFinals-1358

A 25-year-old male patient is scheduled for an appendectomy. The consultant contacts the house officer and requests a prescription for prophylactic antibiotics. What is the recommended prophylactic antibiotic for this patient?

MSFinals-1359

A 50-year-old woman arrives at the Emergency Department after complaining of abdominal pain and black stools since last night. She reports no unintentional weight loss or fresh blood in her stool. Her medical history includes osteoarthritis treated with ibuprofen and well-controlled essential hypertension with candesartan. An upper gastrointestinal endoscopy reveals an actively bleeding gastric ulcer. What major vessel supplies blood to the affected area of her gastrointestinal tract?

MSFinals-1360

A 30-year-old Caucasian woman complains of weight loss, steatorrhoea and diarrhoea. Anaemia and metabolic bone disease are detected during investigations. A small intestine biopsy reveals severe villous atrophy, particularly in the proximal segments. The patient responds well to a gluten-free diet for one year, but her symptoms return despite maintaining the diet. A repeat biopsy shows changes similar to the previous one. What condition should be suspected in this patient?

MSFinals-1361

A 28-year-old male returns from a backpacking trip in Eastern Europe with symptoms of diarrhea. He has been experiencing profuse watery diarrhea and colicky abdominal pain for the past week. He has been going to the toilet approximately 10 times a day and occasionally feels nauseated, but has not vomited. He has lost around 5 kg in weight due to this illness. On examination, he has a temperature of 37.7°C and appears slightly dehydrated. There is some slight tenderness on abdominal examination, but no specific abnormalities are detected. PR examination reveals watery, brown feces. What investigation would be the most appropriate for this patient?

MSFinals-1362

A 50-year-old woman presents to the Gastroenterology Clinic with constipation that has worsened over the past six weeks. She reports straining during defecation. She has a feeling of incomplete evacuation. She has two children who were born via vaginal delivery without history of tears. She has had bladder suspension surgery. On examination, her abdomen is soft and non-distended without palpable masses.
On digital rectal examination, she has an empty rectum. Her resting anal tone is weak but her squeeze tone is normal. She does not relax the puborectalis muscle or the external anal sphincter when simulating defecation; she also has 4-cm perineal descent with straining.
What is the most appropriate investigation to carry out next?

MSFinals-1363

A 58-year-old-man visits his General Practitioner with concerns of constipation and rectal bleeding. He reports a recent loss of appetite and occasional abdominal pain over the past few months. The patient’s blood test results are as follows:
Investigation Result Normal value
Haemoglobin 98 g/l 130 – 180 g/l
Mean corpuscular value (MCV) 93 fl 80 –100 fl
What is the most suitable test to conduct for the diagnosis of this patient?

MSFinals-1364

A 60-year-old woman presents to the Surgical Assessment Unit with mild abdominal pain that has been occurring on and off for several weeks. However, the pain has now worsened, causing her to feel nauseated and lose her appetite. She has not had a bowel movement in 3 days and has not noticed any blood in her stool. Upon examination, her temperature is 38.2 °C, heart rate 110 bpm, and blood pressure 124/82 mmHg. Her abdomen is soft, but she experiences tenderness in the left lower quadrant. Bowel sounds are present but reduced. During rectal examination, tenderness is the only finding. The patient has no history of gastrointestinal issues and only sees her general practitioner for osteoarthritis. She has not had a sexual partner since her husband passed away 2 years ago. Based on the information provided, what is the most probable diagnosis?

MSFinals-1365

A 42-year-old man with end-stage liver disease is admitted with a painful, distended abdomen. Examination findings: generalised abdominal tenderness and ascites. Temperature 37.5 °C.
Which intervention should be undertaken first?

MSFinals-1366

A 32-year-old man presents for a general check-up. He is well in himself and reports no symptoms.
On examination, he has a body mass index (BMI) of 33 kg/m2 and there are some thickened folds of skin in his axilla and the nape of his neck. His blood pressure is 140/90 mmHg. He is a non-smoker and does not drink.
A set of blood work is ordered. He demonstrated impaired fasting glucose in addition to the results below.
Investigation Result Normal value
Haemoglobin (Hb) 140 g/l 135–175 g/l
Cholesterol 5.8 mmol/l < 5.2 mmol/l
Triglyceride 3.9 mmol/l 0–1.5 mmol/l
Alanine aminotransferase (ALT) 60 IU/l 5–30 IU/l
Aspartate aminotransferase (AST) 30 IU/l 10–40 IU/l
Gamma-glutamyl transferase (GGT) 30 IU/l 5–30 IU/l
What is the next best investigation?