Archives: Medical Student Finals

MSFinals-6785

A 72-year-old man is recovering from hip surgery on the ward. He has had an indwelling catheter for several days. In the last 24 hours, he has been noted to have some ‘dizzy spells’ by nurses where he becomes confused and agitated. He has been seen talking to himself, mumbling incoherent ideas, and at other times he seems distracted and disorientated, forgetting where he is. He has a new fever and is tachycardic. The rest of the examination is unremarkable. You suspect he is suffering from delirium.
Which one of the following is most likely to be found in this patient?

MSFinals-6783

A male toddler, on physical examination at the age of 2, is noticed to have an abnormal opening of the urethra on to the ventral surface of the penis.
Which of the following is the most likely diagnosis?

MSFinals-6790

A 75-year-old man presents to the clinic for the second time this year with fever, dysuria, dribbling of urine. Previous admissions were for urinary tract infections. He has a history of hypertension and previous myocardial infarction for which he takes ramipril and rosuvastatin. On examination, he is pyrexial (38.5 °C) and has a pulse of 105/min and his blood pressure (BP) is 142/84 mm Hg. His cardiovascular and respiratory examination is normal. There is suprapubic tenderness with dullness, on percussion, indicating a distended bladder. Per rectal examination reveals a smoothly enlarged prostate.
What is the best next investigation to determine the cause of this patient’s urinary retention?

MSFinals-6789

A 14-year-old boy comes to the Emergency Department with severe scrotal pain that has been ongoing for the past 3 hours. During the examination, he is visibly distressed and his scrotum appears red and tender. He cries out in agony when you try to touch or lift his left testicle. The right testicle appears normal. What test should you perform next?

MSFinals-6794

A 25-year-old man presents to the Emergency Department with a 4-hour history of sudden-onset pain in his left scrotum that makes walking difficult. On examination, his left testicle is firm and diffusely tender.
What is the most urgent management option?

MSFinals-6786

A 50-year-old postal worker presents with a two-day history of increasing right-sided flank pain that extends to the groin. The patient also reports experiencing frank haematuria. The patient has had a similar episode before and was previously diagnosed with a kidney stone. An ultrasound scan confirms the presence of a renal calculi on the right side. What is the most probable underlying cause?

MSFinals-6782

A 30-year-old man undergoes an orchidectomy for a testicular lump. Post-surgery, the histology report reveals the presence of cartilage and columnar epithelial cells. What is the probable diagnosis?

MSFinals-6796

A 19-year-old man comes to the clinic complaining of a painful swelling in the area of his glans penis that has been present for 6 hours. Upon examination, the glans penis is red, oedematous, and extremely tender. The foreskin is pulled back, but there is no evidence of scrotal or penile necrosis or redness.

What is the best course of action for treatment?

MSFinals-6797

A 30-year-old man presents with left scrotal discomfort and a feeling of tightness. Upon examination, there is mild swelling of the left scrotum with varices resembling a bag of worms in the overlying skin that appears dark red. Scrotal ultrasound confirms the presence of a varicocele on the left side. Which structure is most likely dilated in this patient?

MSFinals-6792

A 56-year-old man visits his doctor with complaints of difficulty maintaining an erection, which has been ongoing for some time and is causing problems in his relationship. He is generally healthy, except for high blood pressure that is managed with amlodipine. He reports still experiencing morning erections and has not noticed any changes in his sex drive. During the examination, his blood pressure is measured at 145/78 mmHg, and his BMI is 30 kg/m2. His abdominal, genital, and prostate exams are all normal. What is the most crucial test to rule out any organic causes for his difficulty maintaining an erection?