Archives: Medical Student Finals

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?

MSFinals-6207

A 20-year-old male patient comes in with a midline neck lump that has been present for a long time and measures 3 cm. The lump has been causing occasional pain. Upon protruding his tongue, there is upward movement of the swelling. What is the most probable histological diagnosis for this case?

MSFinals-6208

A 55-year-old motorcyclist is involved in a head-on collision with a truck. The air ambulance arrives at the scene and finds that the patient’s Glasgow Coma Scale (GCS) is 6 (E2, V1, M3) and he has no air entry on the right side of the chest, with an open fractured neck of femur on the left side. His vital signs are as follows: temperature 37.8ºC, heart rate 120 bpm, blood pressure 70/50 mmHg, SpO2 94% on air, and respiratory rate 24/min. The fractured femur is reduced at the scene, but due to the patient’s low GCS, the decision is made to intubate him at the scene. What is the most appropriate agent for induction of anesthesia?

MSFinals-6209

A 67-year-old man presents to the emergency department with central abdominal pain. He denies any fever, weight loss or recent travel. Past medical history included hypertension and appendicectomy for an inflamed appendix 3 years ago.

On examination, there is a firm mass over the abdominal wall. The overlying skin is dusky with signs of ischaemia and necrosis.

Given the signs of ischaemia, you perform a venous blood gas (VBG).

pH 7.22 (7.35-7.45)
pCO2 3.1kPa (4.5-6.0)
pO2 5.1kPa (4.0-5.3)
HCO3- 15 mmol/L (22-26)

Routine work-up to investigate the underlying cause reveals:

Hb 128 g/L Male: (135-180)
Female: (115 – 160)
Platelets 200 * 109/L (150 – 400)
WBC 13 * 109/L (4.0 – 11.0)
Bilirubin 15 µmol/L (3 – 17)
ALP 50 u/L (30 – 100)
ALT 39 u/L (3 – 40)

What is the most likely diagnosis?

MSFinals-6210

A 49-year-old man presents to the Emergency department with excruciating pain in his right loin that has been occurring in waves for the past 2 hours. The physician decides to prescribe analgesia to alleviate his discomfort. What would be the most suitable medication to administer at this point?

MSFinals-6211

An 83-year-old man presents to the emergency department after hitting his head on a cabinet while cleaning. Upon examination 3 hours after the injury, the patient is alert with a GCS of 15. There are no signs of a skull fracture or neurological impairment. The patient reports feeling well, has been alert since the incident, and has not experienced any vomiting. His medical history includes hypertension, atrial fibrillation, and type 2 diabetes mellitus, for which he takes amlodipine, edoxaban, and metformin, respectively. What is the next appropriate course of action?

MSFinals-6213

A 79-year-old man presents to the emergency department referred by his GP due to lower abdominal pain and distension for the past three days. He has been unable to pass stool or flatus. The patient had a laparotomy for a perforated duodenal ulcer 25 years ago. Upon examination, his abdomen is distended and non-tender, and he appears to be in obvious discomfort. The CT scan of his abdomen and pelvis reveals evidence of large bowel obstruction at the splenic flexure. What is the probable cause of his presentation?

MSFinals-6214

Which of the following checks is not included in the pre-operative checklist of the WHO (World Health Organisation) for patients over 60 years of age before the administration of anaesthesia?

MSFinals-6215

A 41-year-old man presents to the emergency department with sudden onset pain in his left leg. The pain has been constant for the past 2 hours. He has been experiencing calf pain when walking for the past few months, which improves with rest. He has no significant medical history and is asymptomatic otherwise.

Upon examination, his left leg appears pale and cool. The anterior tibialis pulse on the left cannot be palpated, but the popliteal pulse is normal. Both pulses on his right leg are normal.

What is the most appropriate course of action for managing this patient?