Archives: Medical Student Finals

MSFinals-0375

A 68-year-old retired ship dockland worker presents to the Medical Outpatient Department with a history of difficulty breathing, hoarse voice, weight loss and occasional night sweats. He also complains of difficulty in swallowing, although this happens very infrequently. He has also noticed that, in the past month, he has become easily tired when performing his daily activities.
On examination, there is unilateral dullness to percussion at the right lung base, decreased breath sounds on the right side, asymmetrical chest wall expansion and scoliosis are observed. A chest X-ray demonstrates diffuse pleural thickening on the right side and decreased right lung volume. A positron emission tomography (PET) scan and video-assisted thoracoscopy (VAT) are performed to obtain the pleural biopsy, and a histopathological diagnosis is made.
Which of the treatments could achieve the best possible outcome in this patient?

MSFinals-0376

What is a true statement about coronary artery grafting for ischaemic heart disease?

MSFinals-0377

A 62-year-old man with advanced-stage non-small cell lung carcinoma, after completing chemotherapy and radiotherapy, is referred to the Surgical Department by his oncologist. He has been experiencing difficulty breathing and right-sided chest pain for the past two weeks. A chest X-ray and CT scan of the chest are ordered. The chest X-ray reveals a large pleural effusion on the right side with a mediastinal shift on the same side, while the CT scan shows thickening of the mediastinal pleura with nodular areas. The patient undergoes pleural aspiration, and the sample is sent for laboratory analysis.

What is the most appropriate initial treatment to alleviate the patient’s symptoms?

MSFinals-0378

An 80-year-old man undergoes surgery to remove his left lung due to advanced non-small cell lung cancer. What is the most fatal complication that may arise from this treatment?

MSFinals-0379

A 38-year-old woman with shortness of breath, fatigue, chest pain, non-productive cough and two documented episodes of pulmonary thromboemboli over the last year undergoes a heart–lung transplant. Her native heart shows massive right ventricular hypertrophy. The lungs show numerous thromboemboli, and the vasculature shows marked medial smooth muscle hypertrophy and atherosclerotic plaques on the main pulmonary arteries.
With which of the following diagnoses are these findings most consistent?

MSFinals-0380

A 70-year-old man with a cigarette habit of 30 per day is being evaluated for operability of his lung carcinoma. One of the parameters being assessed is the angle of bifurcation of the trachea at the carina. In the cadaveric position, where is the typical location of the carina?

MSFinals-0381

At the bifurcation of the trachea, a lesion of the carina is observed during bronchoscopy. Can you determine the vertebral level where this lesion is located?

MSFinals-0382

A 65-year-old man arrives at the Emergency Department (ED) via ambulance with sudden and severe central chest pain that radiates to his back and down his left arm. He has a medical history of hypertension, type 2 diabetes mellitus (controlled by diet), and hypercholesterolemia. Upon examination, he appears pale and sweaty with a heart rate of 120 bpm and blood pressure of 100/60 mmHg on the right arm and 80/50 mmHg on the left arm. An early diastolic murmur is also present. A chest X-ray shows a slightly widened mediastinum with a normal-sized heart and no consolidation or pleural effusions. An electrocardiogram (ECG) reveals ST elevation in leads I, II, and aVF. What immediate management should be implemented?

MSFinals-0383

A 16-year-old girl takes 45 of her stepfather’s aspirin tablets, following an argument with her boyfriend. 12 hours into her admission, the following arterial blood gas (ABG) and biochemistry tests were performed.
pH 7.27, PCO2 3.0 kPa, PO2 14.3 kPa, HCO3− 16.2 mmol/l, base excess −7.4 mmol/l
Na+ 143 mmol/l, K+ 4.5 mmol/l, Cl− 107 mmol/l, urea 12.4 mmol/l, creatinine 87 μmol/l
What is the patient’s anion gap?

MSFinals-0384

A 67-year-old woman was admitted 3 days ago with small bowel obstruction. A nasogastric (NG) tube was inserted, and she began 2 litres of intravenous (IV) fluids daily. She reports feeling short of breath and, on examination has widespread fine crackles on auscultation of her chest and pitting sacral oedema. Her notes show that she weighs 48 kg. You’re-calculate her daily fluid intake.
What is her required daily fluid intake?