Archives: Medical Student Finals

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?

MSFinals-6216

A 26-year-old male patient arrives at the Emergency department complaining of mild left testicular pain and dysuria that has been going on for six days. During the examination, the patient’s scrotum is inflamed, and the epididymis is the most tender area. The patient has a temperature of 37.9°C, and the urine dipstick test came back negative. The cremasteric reflex is present.

What is the most appropriate management plan for the underlying cause of this patient’s symptoms?

MSFinals-6217

A 26-year-old woman complains of a painful lump in her left breast. She has been breastfeeding her baby for two weeks without any issues until four days ago when she noticed the swelling. Upon examination, there is a warm, tender, erythematosus, and fluctuant mass in her left breast. What is the probable diagnosis?

MSFinals-6195

A 28-year-old woman is recovering on the ward after experiencing a subarachnoid haemorrhage 6 days ago. She has been able to maintain her oral fluid intake above 3 litres per day and her heart rate is 72 bpm at rest, while her blood pressure is 146/88 mmHg at rest. Over the last 6 days, her fluid balance shows that she is net positive 650 ml. Her daily blood tests reveal the following results:

– Hb 134 g/l
– Platelets 253 * 109/l
– WBC 5.1 * 109/l
– Neuts 3.9 * 109/l
– Lymphs 1.2 * 109/l
– Na+ 129 mmol/l
– K+ 4.1 mmol/l
– Urea 2.3 mmol/l
– Creatinine 49 µmol/l
– CRP 12.3 mg/l

Paired serum and urine samples show the following:

– Serum Osmolality 263 mosm/l
– Urine Osmolality 599 mosm/l
– Serum Na+ 129 mmol/l
– Urine Na+ 63 mmol/l

What is the most likely reason for the patient’s hyponatraemia?

MSFinals-6196

A 55-year-old male patient, four hours post total thyroidectomy, presents with acute shortness of breath and visible distress. Upon examination, the patient exhibits stridor and a large haematoma is discovered deep to the wound. What is the most appropriate immediate management for this patient?

MSFinals-6197

A 32-year-old man presents to the emergency department with a painful left calf. This has been slowly getting worse for the past 2 days and came without any warning. He uses cocaine regularly but has otherwise no medical history of note. He admits to sometimes using blood vessels on his hands and the front of his elbow to inject.

On examination, the left calf is paler than his right. Radial pulses can be felt, but his extensor digitorum is difficult to find on the left. He is unable to move his left foot. There is no tenderness, changes in calf size or systemic upset.

What is the most likely diagnosis?

MSFinals-6198

An 80-year-old man is brought to the emergency department via ambulance after collapsing. He had complained of abdominal and back pain before falling. The medical team suspects a ruptured abdominal aortic aneurysm. What is the most suitable approach for blood product management in this case?

MSFinals-6199

A 47-year-old alcoholic man presents to the hospital with severe epigastric pain, having been admitted multiple times in the past six months for the same issue. His admission blood work reveals the following:
Na+ 143 mmol/l Bilirubin 8 µmol/l
K+ 3.8 mmol/l ALP 88 u/l
Urea 4.3 mmol/l ALT 33 u/l
Creatinine 88 µmol/l γGT 33 u/l
Amylase 103 u/l Albumin 49 g/l
The medical team suspects chronic pancreatitis. Which imaging modality would be most effective in confirming this diagnosis?