Archives: Medical Student Finals

MSFinals-1218

A 28-year-old man presents with a swelling under the left jaw that comes and goes but leaves a dull ache behind. The problem has been present for around 2 weeks and is getting worse. The pain is most noticeable at mealtimes. In the last day, the swelling has become fixed and he reports an unpleasant taste in his mouth. He smokes five cigarettes a day and drinks ten units of alcohol a week, usually on a Saturday night. On examination, there is a smooth, tender swelling in the superior part of the left anterior triangle and, on inspection of the oral cavity, there is poor dentition and pus present just behind the lower incisors.
Which of the following is the most likely diagnosis?

MSFinals-1219

A 12-year-old girl is brought to the Ear, Nose and Throat (ENT) Outpatient Department by her mother who informs the Consultant of her repeated nosebleeds. She is an avid basketball player, and her mother has noticed multiple bruises after games. The Consultant goes through the list of recent laboratory investigations ordered by the girl’s Paediatrician. Full blood count (FBC), haemoglobin, platelet count, white blood cell count and clotting times [prothrombin time (PT), partial thromboplastin time (PTT)] were all found to be within normal values. Additional haematological test results were also normal, including activity assays for factor VIII and XIII, platelet aggregation assay and von Willebrand factor (vWF) antigen.
Which of the following physical findings would give the most effective information regarding her diagnosis?

MSFinals-1220

A 68-year-old woman presents to her General Practitioner with her husband who has noticed a gradual decrease in hearing on her left side over the past six months. She also reports difficulty walking and a tendency to lean towards the left side. Upon referral to the ENT Department, the Consultant observes nystagmus and dysdiadochokinesia, as well as sensorineural loss in her left ear. What is the most suitable diagnostic test for this patient?

MSFinals-1221

A 20-year-old man presents to his doctor with an enlarging neck mass. His mother had a right adrenal phaeochromocytoma which was successfully removed. The patient is 1.9m tall and weighs 74 kg. During examination, the doctor notices multiple yellowish white masses on the patient’s lips and tongue. Three months later, the patient undergoes a total thyroidectomy. Which structure is innervated by the nerve most at risk during this procedure, and is also part of the vagus nerve?

MSFinals-1222

A 45-year-old man visits his GP complaining of a lump under his chin that causes him pain and swelling, especially after eating a big meal. The facial nerve appears to be functioning normally. Upon examination, there is a tender swelling in the submandibular triangle.
What is the most probable diagnosis?

MSFinals-1223

A 62-year-old man comes to his GP complaining of bothersome tinnitus that has been going on for 6 weeks. He reports hearing a ringing noise in his left ear only and experiencing hearing loss on the left side. The noise is intrusive and is causing him to have trouble sleeping at night. He denies experiencing any vertigo, headache, or other neurological symptoms. He has a medical history of hypertension and takes atenolol for it.
Upon examination, his ears appear normal.
What is the best course of action for managing this patient’s symptoms?

MSFinals-1224

A 70-year-old woman presents following a fall. During an assessment of her fall, she complained of balance problems, nausea and dizziness whenever she moves her head or looks up, eg to hang laundry on her washing line outside. She denies loss of consciousness and did not injure herself during the fall. Her past medical history consists of osteoarthritis of the knees and lower back.
On examination, her gait and balance and neurological examination are normal and there are no injuries. The Hallpike test is positive.
Which of the following is the most appropriate management for this patient’s vertigo?

MSFinals-1225

A 40-year-old patient experiences a severe nose bleed after being hit directly in the nose during a rugby game. The bleeding is resolved with direct pressure and packing of the nose. Which vascular territory is most likely to have been impacted?

MSFinals-1226

A 47-year-old woman presents with a lump in the upper anterior triangle of her neck. She reports that it has been present for a few weeks and only started to bother her after a friend pointed it out. She denies any other symptoms such as weight loss or fevers. She recalls her mother having a similar swelling removed but does not remember the diagnosis. On examination, there is a small, smooth, non-tender, mobile lump. The skin overlying the lump appears normal, and it does not move on swallowing or tongue protrusion. What is the most likely diagnosis?

MSFinals-1227

A surgeon prepares to excise the submandibular gland for a suspected malignancy in a pediatric patient. He incises the skin and the platysma in the neck below the gland, then proceeds to dissect the gland free of its bed. As he dissects the deep lobe, he notes the submandibular duct, which he mobilises, ligates and cuts anteriorly.
When cutting the duct, which of the following needs the most care to be taken to avoid damage?