Archives: Medical Student Finals

MSFinals-1215

Sophie is a 6-year-old overweight girl brought in by anxious parents who are worried about her loud snoring and frequent interruptions in breathing which have been getting progressively worse. Although she has difficulty getting up from sleep, she does not have any daytime somnolence. However, her parents have been receiving complaints from the school teachers about her disruptive and inattentive behaviour in class. They have done a lot of research on the Internet and are demanding that Sophie has her tonsils removed. On examination, Sophie has a short, thick neck and grade III tonsils, but no other abnormalities.
Which of the following is the next best step in management?

MSFinals-1216

A 32-year-old woman comes to your General Practice clinic complaining of worsening hearing and tinnitus. She is currently pregnant and has noticed a significant decline in her hearing, although she had hearing problems before her pregnancy. Her father and grandfather also had hearing problems, and she is concerned about her future. During the examination, both tympanic membranes appear normal without abnormalities detected.
What is the most probable diagnosis?

MSFinals-1217

The patient in the picture has a slow-growing facial lump and has been referred to the Ear, Nose and Throat (ENT) Outpatient Clinic. He denies any other symptoms and is in good health. Radiology confirms a parotid swelling. What is the most likely pathology he has?

MSFinals-1201

A 55-year-old man with advanced cancer of the stomach presents with hoarseness. During the physical examination, the physician notes enlarged deep cervical lymph nodes. What is the cause of the hoarse voice in this patient?

MSFinals-1196

A 6-year-old asylum seeker from Africa presents to the Surgical Outpatient Clinic with a mass on the right side of his neck that has been growing in size. On examination, a mass is found on the side of the neck, behind the sternocleidomastoid muscle, which transilluminates brightly. What is the most probable diagnosis?

MSFinals-1197

A 49-year-old woman presents to her doctor with complaints of constipation and back pain for the past 6 months. Her husband, who accompanies her, also mentions that she has been acting strangely during this time. On examination, a nodule is found in the patient’s neck, just left of the midline. Further investigations reveal an elevated parathyroid hormone level and abnormal levels of various electrolytes. The patient undergoes surgery and subsequently develops hoarseness. What is the most probable cause of the patient’s voice change?

MSFinals-1198

A 65-year-old man, who presented to the Emergency Department a day before for uncontrollable epistaxis, has been admitted following Ear, Nose and Throat (ENT) referral. Bleeding was located and managed by posterior nasal packing. He had no complications following the procedure. However, on the next day, he developed fever, myalgia, hypotension, rashes in the oral mucocutaneous junctions, generalized oedema and several episodes of watery diarrhoea, with nausea and vomiting.
Which of the following investigations/findings would help you make a diagnosis?

MSFinals-1199

A patient with persistent sinusitis is scheduled for endoscopic surgery to address any blockages in the drainage pathways and perform balloon catheter dilation of the paranasal sinus openings. During the procedure, the surgeon aims to access the middle meatus of the nasal cavity to insert a cannula into the ostia.
Which of the paranasal sinuses empties into the sphenoethmoidal recess?

MSFinals-1200

A 38-year-old man presents with a one-month history of feeling a lump in his throat. The feeling comes and goes and has not progressed. He has no difficulty swallowing food or liquids; in fact, eating and drinking help to relieve the symptoms. He has not lost weight. He is a non-smoker. He was recently diagnosed with gastro-oesophageal reflux disease (GORD) and is taking a proton pump inhibitor. He also has chronic sinusitis, for which he takes a steroid nasal spray.
Examination is normal, without cervical lymphadenopathy.
What is the most likely diagnosis in this case?

MSFinals-1184

A 50-year-old male with type 2 diabetes presents for his annual review. Despite following a diet plan, his glycaemic control is not optimal and his most recent HbA1c is 63 mmol/mol (20-46). You decide to initiate treatment with metformin 500 mg bd. As per NICE NG28 guidelines for diabetes management, what is the recommended interval for rechecking his HbA1c after each intensification of treatment?