Archives: Medical Student Finals

MSFinals-1081

A 42-year-old woman visits her General Practitioner (GP) complaining of increasing lethargy and weight gain over the past year. The GP finds nil of note on examination, but decides to carry out some blood tests, the results of which are shown below:
Investigation Result Normal value
Haemoglobin 145 g/l 115–155 g/l
White cell count (WCC) 9.1 × 109/l 4–11 × 109/l
Platelets 263 × 109/l 150–400 × 109/l
Mean corpuscular volume (MCV) 102 fl 76–98 fl
Urea and electrolytes normal, liver function tests (LFTs) normal; thyroid-stimulating hormone (TSH) 10.9 miu/l, free T4 5 pmol/l.
Which of the following statements is correct?

MSFinals-1082

A 44-year-old woman without prior medical history visits her primary care physician complaining of hand pain and overall bone pain that has persisted for four weeks. She also reports experiencing pain in her groin that spreads to her lower back approximately 20 minutes before urination. Additionally, she has been experiencing frequent thirst despite drinking fluids regularly. Laboratory tests reveal hypercalcemia and hypophosphatemia. What is the probable diagnosis?

MSFinals-1083

A 65-year-old male with a 10 year history of hypertension and diabetes has been on a medication regimen for the past two years. He takes metformin 1 g bd, gliclazide 80 mg bd, rosuvastatin 10 mg daily, ramipril 10 mg daily, aspirin 75 mg daily, and amlodipine 10 mg daily. During his annual review, his blood pressure is 138/82 mmHg, and he has background diabetic retinopathy. His foot pulses are normal, but he has peripheral sensory loss to the ankles in both feet. His lab results show HbA1c of 55 mmol/mol (20-46), urea of 12.5 mmol/L (2.5-7.5), creatinine of 176 µmol/L (60-110), and cholesterol of 4.8 mmol/L (<5.2). Which medication should be discontinued?

MSFinals-1085

A 58-year-old man comes to the clinic with a lump in the anterior of his neck. He denies any symptoms of thyrotoxicosis. His family members have noticed that his voice has become increasingly hoarse over the past few weeks. Fine-needle aspiration indicates papillary carcinoma of the thyroid.

Which of the following statements is true?

MSFinals-1086

A 65-year-old male is seeking treatment for hypertension related to his type 2 diabetes. He is currently taking aspirin 75 mg daily, amlodipine 10 mg daily, and atorvastatin 20 mg daily. However, his blood pressure remains consistently high at around 160/92 mmHg.

What medication would you recommend adding to improve this patient’s hypertension?

MSFinals-1087

A 30-year-old female patient complains of anxiety and weight loss. During the examination, a fine tremor of the outstretched hands, lid lag, and a moderate goitre with a bruit are observed. What is the probable diagnosis?

MSFinals-1088

A 50-year-old woman is undergoing evaluation for hypertension that is not responding to treatment. She has a previous medical history of medullary thyroid carcinoma. Her physical examination is unremarkable. During her work-up, she is found to have hypercalcemia with a level of 2.8 mmol/l. Her parathyroid hormone (PTH) is slightly elevated above the normal range. What is the underlying diagnosis?

MSFinals-1089

A 44-year-old chronic smoker was diagnosed with lung cancer 6 months ago after presenting with weight loss, haemoptysis, and shortness of breath. He returns to the Emergency Department complaining of nausea and lethargy that have been worsening over the past 3 weeks. While waiting to see the doctor, he has a seizure. He has a history of hypertension. The following are the results of his investigations:
Investigations Results Normal value
Sodium (Na+) 120 mmol/l 135–145 mmol/l
Serum osmolality 250 mOsmol/kg 280–290 mOsmol/kg
Urine osmolality 1500 mOsmol/kg 50–1200 mOsmol/kg
Haematocrit 27%

What is the most likely diagnosis?

MSFinals-1090

A 55-year-old woman visits her GP with concerns about her susceptibility to osteoporosis. She underwent a hysterectomy and oophorectomy due to uterine fibroids five years ago, which resulted in mild hot flashes that have since subsided. The patient is anxious about the possibility of fractures after her mother broke her hip at the age of 72. She inquires about osteoporosis medications. Her BMI is 17.3 kg/m2, and her T score is <−2.5. She was on Depo-Provera from the age of 39 to 45, during which time she experienced amenorrhea. The physical examination, including breast examination, is normal. What would you suggest to her?