Archives: Medical Student Finals

MSFinals-0396

A patient attends the Emergency Department following a fall. She is 83 and lives alone. On arrival, she is stable, without evidence of significant injury. Her lungs are clear, there is no sign of pedal oedema and she appears well hydrated. You are happy she has come to no harm from the fall. She reports that she has been getting more unsteady over the past few weeks. Routine blood tests reveal the following:
Investigation Result Normal value
Haemoglobin 111 g/dl 115–155 g/dl
White cell count (WCC) 4.7 × 109/l 4–11 × 109/l
Platelets 171 × 109/l 150–400 × 109/l
Sodium (Na+) 119 mmol/l 135–145 mmol/l
Potassium (K+) 4.1 mmol/l 3.5–5.0 mmol/l
Creatinine 125 μmol/l 50–120 µmol/l
What may be the cause of her biochemical abnormality?

MSFinals-0397

A 50-year-old man with coeliac disease arrives at the Emergency Department with sudden-onset left leg pain after a minor injury. He is experiencing difficulty walking. An X-ray of the pelvis reveals a fracture in the neck of the left femur. Routine blood tests are conducted.
What are the expected results of the blood panel?

MSFinals-0398

You run a general practice surgery in the countryside and receive a call late in the evening from the hospital Biochemistry Department. One of your elderly patients had a blood sample sent in by the nurse at the surgery on that morning. She has a history of type II diabetes and hypertension and takes ramipril. Previous urea and electrolytes have been normal with a potassium of 4.9 mmol/l. She works in the city and usually pops into the hospital to get her blood tested.
Investigations:
Investigation Result Normal value
Haemoglobin 130 g/l 135–175 g/l
White cell count (WCC) 5.9 × 109/l 4–11 × 109/l
Platelets 200 × 109/l 150–400 × 109/l
Sodium (Na+) 140 mmol/l 135–145 mmol/l
Potassium (K+) 6.1 mmol/l 3.5–5.0 mmol/l
Creatinine 110 µmol/l 50-120 µmol/l
HbA1c 7.4%
Which of the following is the most likely diagnosis?

MSFinals-0399

A 70-year-old man with metastatic prostate cancer presents with bony leg pain, constipation for 4 days, abdominal pain, thirst and disorientation. On examination, he is cachectic and dehydrated. He is apyrexial and haemodynamically stable. He has a past medical history of hypertension and is an ex-smoker. He has no known drug allergies. His calcium is 3.1 mmol/l and he has normal renal function.
What is the most suitable initial management for this patient?

MSFinals-0400

A 45-year-old woman presented with abdominal swelling, pain and constipation for 5 days. She also complained of generalised aches and pains and feelings of thirst. She had recently been diagnosed with metastatic breast cancer which had recurred. She has a past medical history of irritable bowel syndrome and hypothyroidism. Her regular medications include paracetamol and thyroxine. Her general practitioner (GP) had started her on codeine yesterday. On examination, she appeared dehydrated and had a soft, but mildly distended, abdomen. Thyroid function tested 2 weeks ago was normal.
What is the most likely cause of her presentation?

MSFinals-0370

A 32-year-old woman who has recently returned from holiday to Australia presents to the Emergency Department with sudden-onset chest pain and shortness of breath. The patient has no medical history of note and takes no medication, apart from the combined oral contraceptive pill (COCP).
On examination, the patient is significantly breathless at rest, with a respiratory rate of 30 breaths/min. Oxygen saturations are 91% on high-flow oxygen; her blood pressure is 105/65 mmHg, and her heart rate is 110 bpm and regular. Her temperature is 37.5 °C.
On examination of the chest, breath sounds are normal, with good air entry. No focal signs are found.
Which of the following investigations would be the most appropriate to confirm the likely diagnosis?

MSFinals-0371

A 58-year-old man undergoes a right middle lobectomy of his lung for lung cancer. A chest drain is inserted at the time of surgery to allow full lung reinflation. Three days after the operation, you notice that air bubbles escape through the chest drain into the water seal whenever the patient coughs.
What is the most likely diagnosis?

MSFinals-0372

A 67-year old woman with chronic upper extremity lymphoedema is suspected to have thoracic outlet syndrome secondary to thoracic duct obstruction.
Regarding the thoracic duct, which of the following statements is accurate?

MSFinals-0373

The family of a 63-year-old retired teacher with end-stage heart failure secondary to dilated cardiomyopathy wishes to discuss the possibility of the patient being listed for a heart transplant. The patient is a type 2 diabetic, controlled with diet alone, and has a previous history of basal cell carcinoma, which was successfully removed 12 years ago, without recurrence or complications. The patient’s current body mass index (BMI) is 18. The patient is currently being treated for a cellulitis infection at a previous cannula site.
Which of the following is an absolute contraindication to heart transplantation?

MSFinals-0374

A 67-year-old retired teacher is found to have a 5.7 cm aortic aneurysm, following her abdominal aortic aneurysm (AAA) ultrasound screening test. She is referred to the vascular surgeon to discuss surgical repair of the aneurysm. Which of the following is correct regarding surgical repair of AAAs?