Archives: Medical Student Finals

MSFinals-0426

You are a surgical house officer (F1) attending to a patient on the surgical ward. The nurses mention to you that the patient is having intermittent episodes of pyrexia, without other complaints. The patient is now on their second day following a subtotal thyroidectomy. On assessing the patient, you note that the patient is well in himself and, apart from pyrexia, has no other complaints.
Examination is unremarkable and vital signs are normal, and specifically the neck has no swelling or discharge. A bedside ECG does not reveal any abnormalities. Blood tests are noted as follows:
Investigations Results Normal Values
Haemoglobin (Hb) 111 g/l 135–175 g/l
White cell count (WCC) 8.9 × 109/l 4–11 × 109/l
Platelet (Plt) 415 × 109/l 150–400 × 109/l
Sodium (Na+) 138 mmol/l 135–145 mmol/l
Potassium (K+) 6.3 mmol/l 3.5–5.0 mmol/l
Urea (Ur) 4.5 mmol/l 2.6–6.5 mmol/l
Creatinine (Cr) 35 mmol/l 50–120 mmol/l
C-reactive protein (CRP) 7 mg/l 0–10 mg/l
Liver function tests (LFTs) sample haemolysed
Which of the following interventions would you do first if the patient was 70 years old?

MSFinals-0427

A 56-year-old postmenopausal woman with a 2-year history of invasive ductal carcinoma of the left breast with axillary lymph node involvement presents with confusion and lethargy. She had nausea, vomiting, abdominal pain, constipation, polyuria and polydipsia for 1 week. Investigations show:
Investigation Result Normal values
Sodium (Na+) 144 mmol/l 135–145 mmol/l
Potassium (K+) 3.7 mmol/l 3.5–5.0 mmol/l
Bicarbonate (HCO3-) 23 mmol/l 24–30 mmol/l
PaCO2 5.6 kPa 4.6–6.0 kPa
Corrected Ca2+ 3.47 mmol/l 2.20–2.60 mmol/l
Phosphate (PO43-) 0.55 mmol/l 0.70–1.40 mmol/l
Magnesium (Mg2+) 1.9 mmol/l 0.75–1.00 mmol/l
Which of the following is the most likely cause of these manifestations?

MSFinals-0428

A 72-year-old man visits the Emergency Department with severe sharp pain in the left groin and chronic lower back pain after falling in his garden. He is unable to walk. He has a body mass index (BMI) of 28 kg/m2. His pulse is 80 bpm and regular, blood pressure (BP) 140/80 mm Hg. Fracture of the left neck of the femur is identified on X-ray and treated.
Routine laboratory results are below:
Investigation Result Normal value
Serum calcium concentration 2.1 mmol/l 2.15 – 2.6 mmol/l
Serum phosphate concentration 0.8 mmol/l 0.8 – 1.4 mmol/l
Parathyroid hormone level 60 pg/ml 11 – 54 pg/ml
Urea 5 mmol/l 2.5 – 7.1 mmol/l
Creatinine 80 μmol/l 60 – 110 μmol/l
What is the next most appropriate investigation?

MSFinals-0429

An 85-year-old man has been admitted to the Elderly Care Ward following a fall. He is clinically euvolaemic and does not take diuretics. He is hyponatraemic with the following paired investigation results:
Serum Electrolytes
Investigation Result Normal value
Creatinine 97 μmol/l 50–120 µmol/l
Urea 3.2 mmol/l 2.5–6.5 mmol/l
Sodium 124 mmol/l 135–145 mmol/l
Potassium 4.1 mmol/l 3.5–5.0 mmol/l
Osmolality 200 mmol/l 275-295 mmol/l
Urine Biochemistry
Sodium 32 mmol/l < 20 mmol/l
Osmolality 420 mOsm/l < 100 mOsm/l
What is the most likely diagnosis for this 85-year-old man?

MSFinals-0430

In a clinical trial evaluating the efficacy of two different antiplatelet agents in preventing stroke among elderly patients, a total of 10,000 participants were randomly assigned to receive either the standard therapy or the new therapy. The study spanned five years, during which major gastrointestinal (GI) bleeding was observed in 3% of patients in the standard therapy group and 2% of patients in the new therapy group. What is the absolute risk reduction associated with the new therapy in terms of major GI bleeds?

MSFinals-0431

A study was conducted to evaluate the impact of a new statin in primary prevention for patients with hypertension but no prior cardiovascular event. The study included 200 participants, divided equally into a control group and a treatment group. The average age of the participants was 50 years. The control group had a cardiovascular event rate of 3%, and the number needed to treat (NNT) to prevent one cardiovascular event was 100. What was the rate of cardiovascular events in the treatment group?

MSFinals-0432

A study investigating the effectiveness of D-dimer testing in detecting DVT analyzed the medical records of 800 patients. To be eligible for the study, D-dimer had to be measured and DVT must have been confirmed by ultrasound.
Out of the 800 patients, 720 had positive D-dimers and 80 had negative D-dimers.
What is the sensitivity of D-dimer measurement in identifying DVT?

MSFinals-0404

A 70-year-old woman with metastatic carcinoma of the breast is admitted to your ward, as her family are finding it difficult to cope with her deterioration over the past two weeks. She appears drowsy and lethargic. She has known hepatic and bony secondary lesions.
Her admission blood tests are:
Investigation Result Normal value
Sodium (Na+) 137 mmol/l 135–145 mmol/l
Potassium (K+) 3.9 mmol/l 3.5–5.0 mmol/l
Urea 7.9 mmol/l 2.5–6.5 mmol/l
Creatinine 98 μmol/l 50–120 µmol/l
Calcium Ca2+ 3.13 mmol/l 2.20–2.60 mmol/l
PO43− 0.87 mmol/l 0.70–1.40 mmol/l
Magnesium (Mg2+) 0.91 mmol/l 0.75 –1.00 mmol/l
Albumin 37 g/l 35–55 g/l
Haemoglobin 103 g/l 115–155 g/l
Mean corpuscular volume (MCV) 98.3 fl 76–98 fl
White cell count (WCC) 8.1 × 109/l 4–11 × 109/l
Platelets 186 × 109/l 150–400 × 109/l
Which of the following is the most appropriate initial treatment for this lady’s hypercalcaemia?

MSFinals-0405

A 72-year-old man presents in a severely unwell state. He is unrousable and, on examination, has a blood pressure of 85/40 mmHg with a tachycardia of 110 bpm. His respiratory rate is 35 breaths per minute. There is a past medical history of type II diabetes. A neighbour who attends with the ambulance tells you that the man’s wife died two months earlier. You arrange some investigations.
Investigations:
Investigation Result Normal value
Hameolgobin 122 g/l 135–175 g/l
White cell count (WCC) 10.3 × 109/l 4–11 × 109/l
Platelets 205 × 109/l 150–400 × 109/l
Sodium (Na+) 139 mmol/l 135–145 mmol/l
Potassium (K+) 4.0 mmol/l 3.5–5.0 mmol/l
Chloride 102 mmol/l 98-106 mmol/l
Bicarbonate 14 mmol/l 24–30 mmol/l
Creatinine 190 μmol/l 50–120 µmol/l
Glucose 5.0 mmol/l 3.5–5.5 mmol/l
Lactate 7 mmol/l 0.5–2.2 mmol/l
pH 7.19 7.35–7.45
pO2 10.1 kPa (on oxygen) 10.5–13.5 kPa
pCO2 3.9 kPa 4.6–6.0 kPa
Which of the following is the most likely diagnosis?

MSFinals-0406

A 25-year-old woman presents to the Emergency Department in a state of distress. She is experiencing left carpopedal spasm and tingling around her lips and tongue, along with hyperventilation. Upon further investigation, it is discovered that she has recently received some upsetting news. Her blood work reveals the following results:
pH 7.45
PaO2 11.1 kPa
PaCO2 3.0 kPa
What is the probable reason for her carpopedal spasm?