Archives: Medical Student Finals

MSFinals-0653

An 88-year-old man presents to the Emergency Department with diffuse abdominal pain and one episode of dark rectal bleeding. He is noticed to be in fast atrial fibrillation. He is an ex-smoker and drinks three pints of beer per week. On examination, he is not peritonitic, but his pain is generalised and only temporarily alleviated by opioid analgesia. His bloods show: white blood count 14 (4.5 to 11.0 × 109/l), c-reactive protein 23 (normal: Less than 10 mg/L) and arterial lactate 4.8 (normal 1 ± 0.5 mmol/l4). Abdominal and chest X-rays are unremarkable.
What is the most likely diagnosis?

MSFinals-0654

A 25-year-old woman who recently gave birth presents to the general practitioner with symptoms of rectal bleeding for the past two weeks. She has noticed fresh red blood on the toilet paper after passing a bowel motion, associated with some discomfort and itching around the anus. She has noticed bulging around the anus also. She is otherwise well, without changes in bowel habit or recent weight loss. She is very worried that she may have bowel cancer, as her grandfather was diagnosed with colorectal cancer after episodes of rectal bleeding when he was 81.
What is the most likely diagnosis in this patient?

MSFinals-0655

A 50-year-old man comes to the Gastroenterology Clinic with a 6-month history of rectal bleeding, altered bowel habit and weight loss. Given his strong family history of colorectal cancer, the physician wants to investigate and rule out this diagnosis.

What would be the most suitable investigation to perform in a patient with suspected colorectal cancer?

MSFinals-0656

A 32-year-old man comes to the clinic complaining of fresh blood per rectum. He had previously received treatment for haemorrhoids, including dietary advice, rectal analgesics, and haemorrhoid banding, but his symptoms have persisted. What is the next step in managing this man before conducting an examination under anaesthesia?

MSFinals-0657

You are called to see an 80-year-old man who was admitted for an anterior resection for sigmoid cancer. His operation was uncomplicated, and he is now three days post operation. He has hypercholesterolaemia and hypertension, but was otherwise fit before diagnosis. You find that the man is in atrial fibrillation. Nursing staff report that he is increasingly confused and appears to be in pain despite postoperative pain relief. They also report decreased urine output and tachycardia when they last took observations.
What is the most likely cause of these symptoms?

MSFinals-0658

A 70-year-old woman presents to the Emergency Department with severe lower abdominal pain. The pain started yesterday and is increasing in intensity. She has had loose stools for a few days and has been feeling nauseated. She has not vomited. There is no past medical history of note. On examination, there is tenderness and guarding in the left iliac fossa. Bloods: haemoglobin (Hb) 116 g/l; white cell count (WCC) 15 × 109/l.
What is the most likely diagnosis?

MSFinals-0618

Which statement accurately describes the null hypothesis in a randomized controlled trial comparing drug A to placebo for low back pain treatment?

MSFinals-0620

What are the differences in surface anatomy of abdominal organs from birth to 10 years of age?

MSFinals-0621

A study comparing contrast CT colonography with colonoscopy as the reference technique for detecting large bowel carcinoma was conducted on 500 patients. The data obtained is as follows:
Investigation CT Positive CT Negative
Colonoscopy positive 40 15
Colonoscopy negative 25 420

What is the most accurate description of the performance of CT versus colonoscopy for diagnosing large bowel cancer?