Archives: Medical Student Finals

MSFinals-0973

A 35-year-old woman presents with new-onset diabetes. She has no past drug or treatment history. Her fasting blood glucose is 7.3 mmol/l. Other significant medical history included occasional diarrhoea in the last 4 months, for which she took repeated courses of tinidazole. She also had an episode of severe leg pain three months ago, for which she takes warfarin. She is presently very depressed, as her sister has had renal calculus surgery, which has not gone well; she is in the Intensive Care Unit (ICU) with sepsis.
What is the most appropriate next test?

MSFinals-0974

Through which of the following molecules is the hypercalcaemia of malignancy most commonly mediated?

MSFinals-0975

A 42-year-old teacher presents to the general practitioner (GP) complaining of fatigue and muscle pains. The symptoms have been gradually worsening over the past few months, and now she feels too tired after work to attend her weekly yoga class. She has a history of seasonal allergies and takes antihistamines during the spring and summer. The patient is a non-smoker, drinks occasionally, and follows a vegetarian diet.
During examination, no abnormalities are found, and the GP orders blood tests for further investigation. The results reveal a serum vitamin D (25OHD) level of 18 nmol/l (normal value recommended > 50 nmol/l).
Which molecule involved in the vitamin D synthesis pathway binds to the vitamin D receptor to regulate calcium homeostasis?

MSFinals-0976

A 47-year-old man is diagnosed with hypertension after multiple readings show a blood pressure of 180/110 mmHg. Further investigation reveals a 4.3-cm right-sided adrenal lesion, and he is found to have elevated plasma free metanephrines at 3000 pmol/l (normal range: 80-510 pmol/l). He is scheduled for elective adrenalectomy. What initial treatment should be initiated to prepare this patient for surgery to remove his adrenal phaeochromocytoma?

MSFinals-0977

A 42-year-old obese woman, with a history of type II diabetes mellitus, complains of weight gain during the past 3 years, despite her adherence to a balanced diet. She has diffuse skeletal pain. She is not married and does not have a sexual partner. Her family history is unremarkable. Her blood pressure is 160/105 mmHg. Her face is plethoric and round and she has hypertrichosis of the upper lip (hirsutism). There are purple striae on the abdomen and thigh, and mild wasting of the upper and lower limb muscles. Her full blood count shows a slight increase in the polymorphonuclear leukocyte count, without a left shift. Her haemoglobin is 180 (115–155 g/l).
Which of the following changes in serum calcium, phosphate and parathyroid hormone concentrations would you expect to find in this patient?

MSFinals-0978

A 28-year-old woman visits her doctor complaining of weight loss, fatigue, heart palpitations, excessive sweating, and a lump in her throat that has been present for 2 months. After conducting tests, the doctor discovers a suppressed thyroid-stimulating hormone (TSH). What is the best course of treatment for this patient?

MSFinals-0980

A 25-year-old woman comes to the clinic with a neck nodule that she has observed for the past month. Upon examination, a non-painful 3.5 cm nodule is found on the right side of her neck, located deep to the lower half of the right sternocleidomastoid. The nodule moves upwards when she swallows, and no other masses are palpable in her neck. What is the nature of this mass?

MSFinals-0981

A 65-year-old individual with diabetes complains of difficulty reading newsprint. Fundoscopy reveals clouding of the lens, making it difficult to visualize the retina.
What is the probable reason for this person’s vision impairment?

MSFinals-0982

A cohort of individuals with type I diabetes mellitus, aged 50-60 years, with blood glucose levels between 8.0 and 10.0 mmol/l for a minimum of 10 years, underwent rectal biopsies. The results revealed the presence of osmotic cellular injury in arterioles. What clinical complication is linked with this type of injury?