Archives: Medical Student Finals

MSFinals-6315

A 65-year-old woman presents with severe colicky central abdominal pain, vomiting, and the passage of abnormal stool which had the appearance of redcurrant jelly.

On examination, temperature was 37.5°C, she has a pulse of 120 bpm with an irregular rate. Palpation of the abdomen revealed generalised tenderness and peritonitis.

Investigations reveal:

Haemoglobin 128 g/L (120-160)

White cell count 30 ×109/L (4-11)

Lactate 9 mmol/L (<2) pH 7.10 (7.36-7.44) She was taken to theatre for emergency surgery. What is the likely diagnosis?

MSFinals-6316

A 27-year-old man presents to his GP with a painless lump in his right testicle that has been present for 4 months and has gradually increased in size. He has a medical history of type one diabetes mellitus, coeliac disease, and infertility. Additionally, he is a heavy smoker with a 20 pack-year history and consumes 30 units of alcohol per week. The GP suspects testicular cancer and refers the patient via the two-week-wait pathway. What is the most significant risk factor for this condition based on the patient’s history?

MSFinals-6317

A 35-year-old male patient complains of a painless lump in his right testicle. What is the strongest association of testicular cancer?

MSFinals-6318

A 35 year old woman presents with a 4 week history of increasing redness over her right breast. She is not breastfeeding and reports feeling generally well. Although the area is not painful, she is worried as it has not improved. Upon examination, there is significant swelling and erythema, but no discharge, nipple changes, or palpable masses. Vital signs are normal and she has no fever. Blood test results are as follows:
– White blood cell count: 6×10^9/L
– C-reactive protein: 4 mg/L
– CA 15-3 level: 57 Units/ml (normal range <30 Units/ml)
What is the most likely diagnosis?

MSFinals-6301

An 80-year-old man was diagnosed with prostate cancer two years ago. He had radiotherapy. His prostate specific antigen level (PSA) had been normal until it began to rise four months ago.
He is well informed and asks if he should be on hormone treatment.
When should hormone treatment be initiated in this case?

MSFinals-6293

A 49-year-old woman presents with severe epigastric pain radiating to her back. She has no significant past medical history. On examination, her epigastrium is very tender but not peritonitic. Observations are as follows: heart rate 110 beats per minute, blood pressure 125/75 mmHg, SpO2 96% on air, and temperature 37.2ºC.

Blood results are as follows:

Hb 125 g/L Male: (135-180)
Female: (115 – 160)

Platelets 560 * 109/L (150 – 400)

WBC 14.2 * 109/L (4.0 – 11.0)

Calcium 1.9 mmol/L (2.1-2.6)

Creatinine 110 µmol/L (55 – 120)

CRP 120 mg/L (< 5) Amylase 1420 U/L (40-140) What feature suggests severe disease?

MSFinals-6294

A 56-year-old homeless man is discovered unresponsive on the pavement. Upon arrival at the emergency department, blood tests are conducted, revealing an abnormality – Amylase 1100 U/l. An ultrasound is performed, indicating no biliary tree dilatation. What is the probable reason for this man’s condition?

MSFinals-6295

A 36-year-old woman presents to the hospital with severe epigastric pain and profuse vomiting. She has a history of sarcoidosis currently being treated with prednisolone. She drinks 40 units of alcohol per week. Bloods showed a serum amylase of 3000 U/L. The patient is treated with IV fluids and anti-emetics and is admitted under general surgery.

During your overnight review of the patient, you order urgent blood tests, including an arterial blood gas (ABG). Which blood result would be the most concerning and prompt you to consider an intensive care review?

MSFinals-6296

A 38-year-old male suddenly cries out, grabs the back of his head, and collapses in front of a bystander. After receiving appropriate treatment, he is now recovering in the hospital. As you assess his condition, you begin to consider potential complications that may arise. What is the most probable complication that he may experience due to his underlying diagnosis?

MSFinals-6299

A 21-year-old man is assaulted outside a nightclub and struck with a baseball bat on the left side of his head. He is taken to the emergency department and placed under observation. As his Glasgow coma score (GCS) declines, he falls into a coma. What is the most probable haemodynamic parameter that he will exhibit?