Archives: Medical Student Finals

MSFinals-0932

A 54-year-old female presents with a five day history of fever, cough and malaise. She recently returned from a holiday in southern Spain and has since developed a non-productive cough with chills that have worsened. The patient has a history of smoking 10 cigarettes per day but no other medical history. On examination, she has a temperature of 40°C, blood pressure of 118/72 mmHg, and a pulse of 106 bpm. Chest examination reveals inspiratory crackles at the left base only, with a respiratory rate of 28/min. Baseline investigations show haziness at the left base on CXR, Hb 128 g/L (115-165), WCC 5.5 ×109/L (4-11), Platelets 210 ×109/L (150-400), Sodium 130 mmol/L (137-144), Potassium 3.8 mmol/L (3.5-4.9), Creatinine 100 µmol/L (60-110), Urea 5.2 mmol/L (2.5-7.5), and Glucose 5.5 mmol/L (3.0-6.0). What is the most likely diagnosis?

MSFinals-0933

A 25-year-old male patient arrives at the emergency department with symptoms of vomiting and dehydration. He reports a two-month history of weight loss and excessive thirst. Upon examination, the patient is diagnosed with diabetic ketoacidosis, with a blood glucose level of 29.3 mmol/L (3.0-6.0), a pH of 7.12 (7.36-7.44) on blood gas analysis, and +++ ketones in the urine. What is the percentage of individuals with type 1 diabetes who are initially diagnosed after presenting with diabetic ketoacidosis?

MSFinals-0934

A 28-year-old male with type 1 diabetes is instructed to collect his urine for 24 hours. What level of urine albumin concentration indicates the presence of microalbuminuria?

MSFinals-0935

A 33-year-old woman with Addison’s disease is currently taking hydrocortisone 10 mg in the morning and 10 mg in the evening, but she has been struggling with poor compliance. She believes that the hydrocortisone is causing stomach upset and is interested in switching to enteric coated prednisolone. What would be the appropriate daily dose of prednisolone for her?

MSFinals-0936

A 45-year-old woman with Addison’s disease has arrived at a remote clinic. She reports that she has finished her supply of hydrocortisone, which she typically takes 20 mg in the morning and 10 mg in the evening. Unfortunately, the clinic does not have hydrocortisone available, but prednisolone is an option until hydrocortisone can be obtained. What is the daily dosage of prednisolone that is equivalent to her usual hydrocortisone dosage?

MSFinals-0937

A 49-year-old woman with a history of type 2 diabetes for three years comes in for her annual check-up. Despite optimizing her oral hypoglycemic therapy, she has gained around 5 kg in weight over the past year and her HbA1c has worsened. She is also taking ramipril, bendroflumethiazide, and amlodipine, but her blood pressure remains difficult to control, with a reading of 172/102 mmHg. During the examination, she has developed abdominal striae, thin skin with bruising, and proximal weakness. The doctor suspects Cushing’s syndrome. What is the most appropriate test for this patient?

MSFinals-0938

A 45-year-old man presents to his general practitioner (GP) for a check-up following prescription of an angiotensin-converting enzyme (ACE) inhibitor for hypertension. He reports no side-effects of the medication. On measurement of his blood pressure, it is recorded as 176/140 mmHg. The GP repeats the measurement and records similar values. The physician considers secondary causes of hypertension and enquires about symptoms associated with some of the causes. The patient reports headache, sweating and occasional palpitations. On examination, he has a pulse rate of 110 bpm and dilation of both pupils. The GP suspects the patient may be suffering from the rare condition known as phaeochromocytoma.
What percentage of cases of phaeochromocytoma are due to a malignant cause?

MSFinals-0940

A 16-year-old girl visits her General Practitioner, concerned about her family’s history of cardiovascular disease and wanting to investigate her own health after learning about healthy eating in school. She was found to have a fasting plasma cholesterol of 15 mmol/l.
What is the most probable reason for these findings?

MSFinals-0941

A 63-year-old man presents to his primary care physician with complaints of feeling tired and dizzy upon standing up. His family members are worried because they have noticed a change in his facial appearance. Upon further investigation, the following laboratory results were obtained:
Serum:
Na+ 128 mmol/l (135–145 mmol/l)
K+ 6.1 mmol/l (3.5–5 mmol/l)
Short adrenocorticotropic hormone (ACTH) stimulation test:
Plasma cortisol:
0900 h 150 nmol/l (140–690 nmol/l)
30 min after ACTH: 155 nmol/l
60 min after ACTH: 155 nmol/l
0900 h ACTH: 6 ng/l (normal <50 ng/l)
What condition is consistent with these findings?