Archives: Medical Student Finals

MSFinals-0835

A middle-aged homeless man in his early 50s is brought to the emergency department with a six hour history of profuse vomiting. He complains of nausea and headache.

The history available is sketchy. He is of no fixed abode and denies having any previous medical problems. He appears unkempt and is confused – oriented to person but not time or place. He is afebrile. His breath smells of ketones.

Twelve hours after admission his condition deteriorates. He complains of blurred vision and his pupils are fixed and dilated; his respiratory rate increases sharply over the next few minutes and he becomes unconscious.

Investigations show:

Hb 138 g/L (130-180)
WCC 7.1 ×109/L (4-11)
Platelets 401 ×109/L (150-400)
Plasma sodium 135 mmol/L (137-144)
Plasma potassium 5.0 mmol/L (3.5-4.9)
Plasma urea 5.8 mmol/L (2.5-7.5)
Plasma creatinine 110 µmol/L (60-110)
Plasma chloride 100 mmol/L (95-107)
Plasma bicarbonate 12 mmol/L (20-28)
Plasma glucose 5.5 mmol/L (3.0-6.0)
Plasma lactate 4.1 mmol/L (0.6-1.7)
PaO2 12 kPa (11.3-12.6)
PaCO2 4.2 kPa (4.7-6.0)
pH 7.22 (7.36-7.44)
Urine microscopy Crystals seen

What is the calculated anion gap in this case?

MSFinals-0836

A 29-year-old female presents to the surgical intake with abdominal pain and a five day history of vomiting.

Over the last three months she has also been aware of a 6 kg weight loss.

On examination, she is pale, has a temperature of 38.5°C, blood pressure of 90/60 mmHg and pulse rate of 130 in sinus rhythm. The chest is clear on auscultation but she has a diffusely tender abdomen without guarding. Her BM reading is 2.5.

Initial biochemistry is as follows:

Sodium 124 mmol/L (137-144)

Potassium 6.0 mmol/L (3.5-4.9)

Urea 7.5 mmol/L (2.5-7.5)

Creatinine 78 µmol/L (60-110)

Glucose 2.0 mmol/L (3.0-6.0)

What is the likely diagnosis?

MSFinals-0837

A 16-year-old girl and her mother rush to the Emergency department due to the girl’s sudden onset of breathlessness and facial puffiness. The girl has a history of eczema and is currently taking oral contraceptives. Despite being well prior to this incident, she is now visibly distressed and experiencing laboured breathing with stridor but no wheezing. What is the most probable reason for her breathlessness?

MSFinals-0838

A 57-year-old man who has been physically active throughout his life experiences a sudden onset of severe chest pain that spreads to his back, causing him to lose consciousness within minutes. He has a medical history of hypertension, but a recent treadmill test showed no signs of cardiac disease. What is the most probable diagnosis?

MSFinals-0805

A 35-year-old female patient complains of erythematous papulo-pustular lesions on the convexities of her face for the past two years. She also has a history of erythema and telangiectasia. What is the most probable diagnosis for this patient?

MSFinals-0806

A 35-year-old patient with a chronic skin condition is under annual review with the Dermatology team. At her review appointment, the patient mentions that she has been experiencing episodes of new skin lesions appearing in areas where she has scratched, often appearing in straight lines. The doctor examines a typical lesion, and notes that they are examples of Koebner phenomenon.
In which one of the following conditions is the Koebner phenomenon MOST likely to be seen?

MSFinals-0808

A 6-year-old girl with known coeliac disease develops a symmetrical prurigo with numerous vesicles on her shoulders, back, and buttocks. She is also currently experiencing several mouth ulcers.
What is the probable diagnosis for her skin rash?

MSFinals-0809

A 38-year-old man presents with thick, demarcated, erythematous plaques with silvery scaling over the extensor surface of the elbows and knees. He has had these skin lesions on and off over the last 2 years. The lesions become less severe during summer, aggravate at the time of stress and recur at the site of skin trauma. Histopathological examination of the skin biopsy specimen shows epidermal hyperplasia and parakeratosis, with neutrophils inside the epidermis.
What is the most likely diagnosis in this patient?