Archives: Medical Student Finals

MSFinals-0632

A 38-year-old male with a history of alcohol abuse is under the care of a nursing home due to a diagnosis of Wernicke’s encephalopathy. What vitamin deficiency is the cause of this condition?

MSFinals-0633

A 65-year-old homeless man who also abuses alcohol but has been abstinent for 3 years is seeking advice from relief medical staff at a homeless shelter regarding his sore gums. He has noticed coiled body hairs with small bruises at their points of insertion. Additionally, he has observed that when he cuts himself or experiences trauma, the wounds take longer to heal than expected. What is the most probable issue?

MSFinals-0634

A 58-year-old patient presents to the clinic with a chief complaint of reduced night vision. Upon reviewing the patient’s medical history, it is noted that they have a history of pancreatic insufficiency and experience chronic diarrhea and malabsorption.

Which vitamin deficiency is commonly associated with issues related to night vision?

MSFinals-0635

An 80-year-old man who lives alone and prepares his own food is discovered to have multiple ecchymotic haemorrhagic areas surrounding his hair follicles. The hairs are broken, and various haematomas are present in the muscles of his arms and legs. Other than the absence of teeth, the remainder of the physical examination is unremarkable. Laboratory testing reveals a normal prothrombin time, APTT, and a full blood count that is normal except for a haematocrit of 28%. Which deficiency is most likely to account for this patient’s symptoms?

MSFinals-0636

You are evaluating a 70-year-old man with a history of two previous TIAs and an inferior myocardial infarction. He is a heavy smoker, consuming 40 cigarettes per day. You suspect the presence of an abdominal aortic aneurysm (AAA) and are curious about the typical characteristics of a large AAA that has not yet ruptured.

MSFinals-0637

A 60-year-old man presents with complaints of fatigue and general discomfort. He is overweight and has a history of hypertension, which is currently being treated. He does not smoke and drinks very little alcohol. His blood pressure is 129/80 mmHg and his BMI is 30 kg/m2. Upon conducting fasting blood tests, the following results were obtained: glucose 8.5 mmol/L (3.0-6.0), total cholesterol 6.7 mmol/L (<5.2), triglycerides 9.3 mmol/L (0.45-1.69), HDL 1.3 mmol/L (>1.55), and LDL unable to calculate due to high triglycerides. He was diagnosed with diabetes mellitus and was referred to a dietitian and practice nurse for further management.

Nine months later, the patient returned for a follow-up appointment. He had been taking fenofibrate 160 mg OD and metformin 1g BD for the past three months and had lost some weight, bringing his BMI down to 28 kg/m2. A repeat lipid profile was conducted and compared to the previous results. The cholesterol level had decreased from 5.4 to 3.9 (<5.2), triglycerides had decreased from 3.7 to 1.5 (0.45-1.69), HDL had decreased from 1.2 to 0.5 (1.55), and calculated LDL had increased from 2.5 to 2.72 (<3.36). The patient's low HDL level was a cause for concern. What is the likely cause of the patient’s low HDL level?

MSFinals-0638

A cohort study of 5,000 elderly patients aimed to determine whether the consumption of green tea has an effect on cognitive decline. Roughly half of the patients drank green tea regularly and half did not.
What is a drawback of conducting a cohort study?

MSFinals-0602

Which condition is most likely to result in a pleural effusion that is classified as a transudate with protein levels below 30 mg/L?

MSFinals-0603

A 67-year-old male is admitted with an intracranial bleed and is under the care of the neurosurgeons. After undergoing magnetic resonance angiography, he undergoes clipping of a cerebral arterial aneurysm and is stable the following morning. The surgical team records the following blood chemistry results on successive postoperative days:

Day 1:
– Plasma Sodium: 130 mmol/L
– Potassium: 3.5 mmol/L
– Urea: 4.2 mmol/L
– Creatinine: 95 µmol/L

Day 2:
– Plasma Sodium: 127 mmol/L
– Potassium: 3.4 mmol/L
– Urea: 4.2 mmol/L
– Creatinine: 90 µmol/L

Day 3:
– Plasma Sodium: 124 mmol/L
– Potassium: 3.4 mmol/L
– Urea: 4.4 mmol/L
– Creatinine: 76 µmol/L

Day 4:
– Plasma Sodium: 120 mmol/L
– Potassium: 3.5 mmol/L
– Urea: 5.0 mmol/L
– Creatinine: 70 µmol/L

Normal Ranges:
– Plasma sodium: 137-144 mmol/L
– Potassium: 3.5-4.9 mmol/L
– Urea: 2.5-7.5 mmol/L
– Creatinine: 60-110 µmol/L

On day four, the patient is put on a fluid restriction of 1 litre per day. Investigations at that time show:
– Plasma osmolality: 262 mOsmol/L (278-305)
– Urine osmolality: 700 mOsmol/L (350-1000)
– Urine sodium: 70 mmol/L –

What is the most likely diagnosis to explain these findings?