Archives: Medical Student Finals

MSFinals-6228

A 42-year-old male presents to the emergency department with intermittent abdominal pain in the right upper quadrant (RUQ). The pain started 3 hours ago, and is described as a sharp pain that comes and goes. The pain does not radiate anywhere, but it has progressively worsened throughout the day.

Upon examination, the patient appears to be in pain at rest, but does not appear clammy or pale. He is very tender in the right upper quadrant, but no guarding or rebound tenderness is felt.

His vital signs are as follows:
Heart rate = 105 beats per minute.
Respiratory rate = 20 breaths per minute.
Blood pressure = 130/85 mmHg.
Temperature = 38.5ºC.

What is the most appropriate next investigation to perform?

MSFinals-6229

A 54-year-old woman presents to the Emergency Department with sudden onset upper abdominal pain radiating to the back. She reports experiencing similar pain in the past, especially after eating, but this episode is the most severe. Her medical history includes type 2 diabetes mellitus, chronic kidney disease (CKD), and hypercholesterolemia. She does not smoke or drink alcohol. On examination, there is tenderness to palpation of the epigastrium. Blood tests are ordered, and the results are as follows:
– Bilirubin: 28 µmol/L (3 – 17)
– ALP: 321 µmol/L (30 – 100)
– AST: 93 iu/L (3 – 30)
– Amylase: 1090 u/L (70 – 300)
– Calcium: 1.92 mmol/L (2.1 – 2.6)

What is the most appropriate next step in investigating the likely cause of her symptoms?

MSFinals-6230

An 82-year-old man presents to the emergency department with severe constipation and abdominal pain. He has vomited five times in the last three days and has not passed air or faeces for the two.

Upon examination, his abdomen is very distended with diffuse tenderness and tinkling bowel sounds are heard on auscultation. The patient had undergone surgery for a perforated peptic ulcer two years ago. He has a medical history of asthma and type two diabetes.

What is the most likely diagnosis, and what is the gold standard investigation for confirming it?

MSFinals-6231

A 45-year-old man comes to the Emergency Department complaining of severe retrosternal pain that has been ongoing for 3 hours. He reports having consumed a large amount of alcohol yesterday, resulting in significant regurgitation. On palpation of the chest wall, crepitus is detected. His ECG reveals sinus tachycardia. What test should be conducted to confirm the probable diagnosis?

MSFinals-6232

A 50-year-old male is recovering on the surgical ward two days post-open inguinal hernia repair. He has no other past medical history of note.

He has not opened his bowels or passed wind for the last 48 hours. His abdomen is diffusely distended and tender. There is no rebound tenderness. There are no bowel sounds on auscultation. He is currently nil by mouth with a nasogastric tube placed.

His observations are as follows:
Respiratory rate 20 breaths per minute
Heart rate 110 beats per minute
Blood pressure 100/60 mmHg
Temperature 37.3ºC

Which of the following investigations is most likely to identify factors which are contributing to this patient’s postoperative complication?

MSFinals-6233

A 68-year-old man presents to the Emergency Department with worsening abdominal pain over the past two days. The pain started in the lower left side of his abdomen and he has been experiencing diarrhoea. He has a medical history of hypertension, chronic kidney disease, and diverticular disease. On examination, his heart rate is 120 bpm, blood pressure is 135/80 mmHg, temperature is 38.5ºC, and oxygen saturation is 96% on air. His abdomen is tender throughout with involuntary guarding and rebound tenderness. Blood tests reveal the following results:
Hb 140 g/l Na+ 140 mmol/l Bilirubin 9 µmol/l
Platelets 730 * 109/l K+ 4.2 mmol/l ALP 70 u/l
WBC 18.9 * 109/l Urea 6.3 mmol/l ALT 36 u/l
Neuts 16.1 * 109/l Creatinine 115 µmol/l γGT 57 u/l
Lymphs 2.0 * 109/l Amylase 8 u/l Albumin 35 g/l

Which diagnostic test would be most appropriate to confirm the diagnosis?

MSFinals-6234

A 26-year-old man and his partner visit the GP with a complaint of left-sided testicular pain that has been bothering him for the past 5 days. Upon examination, the left testicle appears swollen and red, and the pain subsides when the testicle is elevated. There are no signs of penile discharge or palpable masses. The right testicle appears normal. What is the most probable causative organism responsible for this man’s condition?

MSFinals-6235

A 32-year-old male patient arrives at the emergency department complaining of left testicular pain that has been ongoing for three days. He reports a burning sensation during urination but denies any urethral discharge. The patient is sexually active and has no history of sexually transmitted diseases, trauma, or similar episodes. Upon examination, the left testicle is found to be swollen and tender. What is the most probable organism responsible for this condition?

MSFinals-6205

An 80-year-old man presents to the emergency department with urinary retention. Upon examination, a catheter is inserted and 900 ml of residual urine is drained. The patient also complains of upper back pain over the spinal vertebrae. The patient has a history of metastatic prostate cancer and has recently started treatment. What type of prostate cancer treatment is the patient likely receiving?

MSFinals-6206

A 56-year-old woman with advanced multiple sclerosis has been experiencing diarrhoea for the past 3 days. She reports no blood in her stool, no abdominal pain, and no fever. Due to her limited mobility, she is currently receiving nasogastric tube feeding. Her recent blood work shows a hemoglobin level of 117 g/L (normal range for females: 115-160 g/L), platelet count of 349 * 109/L (normal range: 150-400 * 109/L), white blood cell count of 10.2 * 109/L (normal range: 4.0-11.0 * 109/L), sodium level of 146 mmol/L (normal range: 135-145 mmol/L), potassium level of 4.9 mmol/L (normal range: 3.5-5.0 mmol/L), urea level of 7.1 mmol/L (normal range: 2.0-7.0 mmol/L), and creatinine level of 58 µmol/L (normal range: 55-120 µmol/L). Her C-reactive protein level is 2 mg/L (normal range: <5 mg/L). What is the most likely cause of her diarrhoea?