Archives: Medical Student Finals

MSFinals-1314

A 35-year-old General Practice manager is referred to the Gastroenterology Clinic with a 2-year history of gastroenterological complaints. The patient reports abdominal bloating, especially after meals and in the evenings, and alternating symptoms of diarrhoea and constipation. She also has a history of anxiety and is currently very busy at work – she feels this is also having an impact on her symptoms, as her symptoms tend to settle when she is on leave.
Which one of the following features in the clinical history would point towards a likely organic cause of abdominal pain (ie non-functional) diagnosis?

MSFinals-1315

A 50-year-old construction worker presents with a haematemesis.

His wife provides a history that he has consumed approximately six cans of beer per day together with liberal quantities of whiskey for many years. He has attempted to quit drinking in the past but was unsuccessful.

Upon examination, he appears distressed and disoriented. His pulse is 110 beats per minute and blood pressure is 112/80 mmHg. He has several spider naevi over his chest. Abdominal examination reveals a distended abdomen with ascites.

What would be your next course of action for this patient?

MSFinals-1316

A 59-year-old man presents with worsening jaundice over the past two months. He denies any abdominal pain but reports that his stools have been paler than usual and his urine has been dark. The man is currently taking sulfasalazine for ulcerative colitis and has recently returned from a trip to Tanzania. On examination, he has hepatomegaly and is stable in terms of temperature and blood pressure.
What is the probable reason for the man’s symptoms?

MSFinals-1317

A 30-year-old woman presents to the Outpatient Department with a few months’ history of increasing malaise, nausea and decreased appetite. She is a known intravenous drug user. During examination, she appears cachectic and unwell. Mild hepatomegaly and icterus of the sclerae are also noted. Blood tests reveal normal bilirubin, alkaline phosphatase (ALP) and γ-glutamyl transpeptidase (GT) levels and markedly deranged aspartate transaminase (AST) and alanine transaminase (ALT) levels. She cannot recall her hepatitis B immunisation status. Viral serology is conducted:
Test Patient
HBsAg +ve
Anti-HBsAg -ve
HBcAg +ve
IgM anti-HBcAg -ve
IgG anti-HBcAg +ve
HBeAg +ve
Anti-HBeAg -ve
What is the correct interpretation of this woman’s hepatitis B status?

MSFinals-1318

A man with known ulcerative colitis presents to Accident and Emergency with a flare-up. He tells you that he is passing eight stools a day with blood and has severe nausea with abdominal pain at present. He normally takes oral mesalazine to control his condition. On examination, the patient is cool peripherally, with a heart rate of 120 bpm and blood pressure of 140/80 mmHg. Blood tests are done and relevant findings shown below.
Investigation Result Normal value
Erythrocyte sedimentation rate (ESR) 32 mm/hour < 20 mm/hour
Albumin 34 g/l 35–50 g/l
Temperature 37.9 °C 36.1–37.2 °C
Haemoglobin 98 g/l 115–155 g/l
Which of the following is the most appropriate management of this patient?

MSFinals-1319

A 49-year-old man is admitted with chronic alcoholic liver disease. He gives little history himself. On examination, he has grade 1 encephalopathy, a liver enlarged by 4 cm and clinically significant ascites.
Which one of the following combinations is most reflective of synthetic liver function?

MSFinals-1320

A 50-year-old man comes to the clinic complaining of restlessness and drowsiness. He has a history of consuming more than fifty units of alcohol per week. During the examination, he displays a broad-based gait and bilateral lateral rectus muscle palsy, as well as nystagmus. What is the probable diagnosis?

MSFinals-1321

A 35-year-old woman was brought to the Emergency Department with confusion. She has a history of manic illness. There is no evidence of alcohol or drug abuse. Upon examination, she displays mild jaundice and signs of chronic liver disease, such as spider naevi and palmar erythema. Additionally, there is a brownish ring discoloration at the limbus of the cornea.
Blood tests reveal:
Investigation Result Normal value
Bilirubin 130 μmol/l 2–17 µmol/l
Alanine aminotransferase (ALT) 85 IU/l 5–30 IU/l
Ferritin 100 μg/l 10–120 µg/l
What is the most likely diagnosis based on this clinical presentation?

MSFinals-1322

A 25-year-old man presents with bilateral tremor of his hands and abdominal pain. He is a recent graduate of engineering from the local university, and has been having increasing difficulty using tools. The abdominal pain has been constant over the last 3 weeks. Over the last 8 months his family have noticed a significant change in his behaviour, with several episodes of depression interspersed with episodes of excessive drinking – both of which are very unusual for him. On examination he has resting tremor bilateral, is slightly hypertonic and has bradykinesia. The examining physician has noted brownish iris of both eyes. The patient has not noticed any change in his colouring. His liver function tests are as follows:
serum bilirubin: 18.9 µmol/l (normal 3–17 µmol/l)
serum ALT: 176 IU/l (normal 3–40 IU/l)
serum AST: 254 IU/l (normal 3–30 IU/l)
serum ALP: 259 µmol/l (normal 30–100 µmol/l)
γ-glutamyl transferase (GT): 49 IU/l (normal 8–60 IU/l).
What is the most likely diagnosis?

MSFinals-1323

A 45-year-old man presents with abnormal liver function tests. He reports being a teetotaler and having no 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 115 U/L (45-105), serum ferritin is 1360 μg/L (15-300), and serum iron saturation is 84%. What is the likely diagnosis?