Archives: Medical Student Finals

MSFinals-0571

A 65-year-old woman presents with complaints of generalized aches and lack of energy. Her urea and electrolyte concentrations are within normal limits, but her corrected calcium concentration is 1.98 mmol/L (normal range: 2.2-2.6) and phosphate is low at 0.66 mmol/L (normal range: 0.8-1.4). Further tests reveal that her 25-hydroxy vitamin D level is 12 IU/L (normal range: 15-50) and parathyroid hormone level is 25 (normal range: 3-6). What is the most likely diagnosis?

MSFinals-0572

A 65-year-old male presents with complaints of fatigue, excessive thirst, and frequent urination despite normal blood sugar levels. Upon examination, the following results are obtained:

– Serum sodium: 135 mmol/L (133-144)
– Serum urea: 5.8 mmol/L (2.5-7.5)
– Serum creatinine: 100 μmol/L (50-100)
– Serum calcium: 2.78 mmol/L (2.20 – 2.60)
– Serum albumin: 28 g/L (35-50)
– Corrected calcium: 3.02 mmol/L (2.20-2.60)
– Serum phosphate: 0.87 mmol/L (0.80 – 1.45)
– Serum alk phosphatase: 117 IU/L (30-115)
– Serum asp transaminase: 39 I U/L (5-45)
– Serum bilirubin: 8 umol/L (1-17)

What further investigation would you recommend?

MSFinals-0574

A 35-year-old woman experiences a significant tear in the posterior region during childbirth, raising concerns about potential damage to the muscles that support continence. What structures offer the most muscular support to the pelvic floor?

MSFinals-0576

A 26-year-old rugby player presents to the clinic with complaints of decreased sensation in the upper right shoulder region. He has a history of multiple anterior shoulder dislocations. Upon examination, you note reduced sensation over the regimental badge area. What nerve is most likely to have been affected?

MSFinals-0577

A 55-year-old woman reports experiencing numbness and tingling in her hands during the early morning hours. She has noticed difficulty holding small tools for her hobby of model making. During a clinic examination, Tinel’s sign is positive and there is a loss of sensation over the palmar aspect of the lateral three and a half digits. What nerve injury is most likely present?

MSFinals-0578

Which nerve is affected when you experience tingling and numbness in the palmar surface of the ring and little finger after being struck on the elbow from behind over the medial side?

MSFinals-0579

Which nerve (and corresponding nerve root) are you assessing when eliciting the triceps reflex during a neurological examination of the upper limb by striking the triceps tendon with a tendon hammer while the patient’s arm is flexed at 90° across their chest?