Archives: Medical Student Finals

MSFinals-1177

A 65-year-old man visits his GP complaining of erectile dysfunction that has been ongoing for the past year. He has no prior history of this issue and is greatly troubled by it. The patient has a medical history of type II diabetes mellitus, hypertension, ischaemic heart disease, and poor urinary flow. He also had a thyroidectomy a few years ago, the reason for which is unclear. He is currently taking insulin, gliclazide, amlodipine, and aspirin. His most recent HbA1c was 12.1% or 108 mmol/mol. What is the probable cause of his erectile dysfunction?

MSFinals-1178

A 35-year-old patient presents to her doctor with complaints of excessive sweating and feeling very warm. Upon examination, no significant thyroid nodule is observed. The patient’s blood tests reveal the following results:
Investigation Result Normal value
Thyroid-stimulating hormone (TSH) < 0.1 µU/l 0.4–4.0 µU/l
Free thyroxine (T4) 30 pmol/l 10–20 pmol/l
What is the most probable diagnosis?

MSFinals-1179

A 35-year-old woman presents to her general practice with a lump in her neck. During examination, the GP observes a diffusely enlarged thyroid swelling with an audible bruit but no retrosternal extension. The patient reports no difficulty with breathing or swallowing. The patient appears underweight and anxious, with a pulse rate of 110 bpm and signs of proptosis, periorbital oedema, lid retraction and diplopia. The GP suspects hyperthyroidism and refers the patient to the Endocrinology Clinic.
What is the most common cause of hyperthyroidism?

MSFinals-1180

A 30-year-old female patient comes in for her annual check-up. She was diagnosed with diabetes mellitus at the age of 20 and is currently being treated with human mixed insulin twice daily. She has been experiencing dysuria for the past year and has received treatment with trimethoprim four times for cystitis. On examination, there are two dot haemorrhages bilaterally on fundal examination, but no other abnormalities are found. Her blood pressure is 116/76 mmHg. The following investigations were conducted: HbA1c 75 mmol/mol (20-46), fasting plasma glucose 12.1 mmol/L (3.0-6.0), serum sodium 138 mmol/L (137-144), serum potassium 3.6 mmol/L (3.5-4.9), serum urea 4.5 mmol/L (2.5-7.5), serum creatinine 90 µmol/L (60-110), urinalysis glucose +, and 24-hour urine albumin 220 mg/24 hrs (<200). What is the best treatment option to prevent the progression of renal disease?

MSFinals-1181

A 42-year-old woman presents to her general practitioner (GP) with complaints of feeling ‘run down’. She reports increasing fatigue and lethargy over the past few months. Her appetite is poor, but she is gaining weight, and she is experiencing constipation. On examination, her skin is dry and cold. She has a painless midline neck swelling, which feels irregular and rubbery. The GP orders blood tests to investigate the cause of the patient’s symptoms.
What would you anticipate to observe on the thyroid function tests?

MSFinals-1182

A 40-year-old woman presents to her GP with complaints of fatigue, lethargy, flu-like myalgias, and syncopal episodes. She also reports feeling low in mood. Upon investigation, the following results were obtained:
Serum:
Investigation Result Normal value
Sodium (Na+) 127 mmol/l 135–145 mmol/l
Potassium (K+) 5.7 mmol/l 3.5–5.0 mmol/l
Short adrenocorticotropic hormone (ACTH) stimulation test:
Plasma cortisol:
0900 h 145 nmol/l
30 min after ACTH 210 nmol/l
60 min after ACTH 350 nmol/l
0900 h ACTH: 4 pg/ml (<5 pg/ml low)
What is the most likely diagnosis?

MSFinals-1183

A 30-year-old woman complains of menstrual irregularity and galactorrhoea for the past year. She also experiences occasional headaches. During examination, she was found to have bitemporal superior quadrantanopia. What is the most probable diagnosis?

MSFinals-1152

A 55-year-old male with a history of diabetes mellitus for five years presents with restricted myocardial dysfunction and skin pigmentation. His ALT level is elevated at 153 IU/L. What is the most suitable investigation for this patient?

MSFinals-1153

A 55-year-old man comes to his GP complaining of tingling in both hands that began a month ago and has been progressively worsening. He has no significant medical history. During the examination, you observe that the man has large hands, widely spaced teeth, and a prominent brow. You suspect that he may have acromegaly.
What is the most suitable initial investigation for acromegaly?

MSFinals-1154

A 47-year-old female is worried about the possibility of developing obesity and its connection to the metabolic syndrome and diabetes. She is seeking information on the specific criteria for diagnosing the metabolic syndrome.

Which of the following is a specific criterion used in diagnosing the metabolic syndrome?