Archives: Medical Student Finals

MSFinals-0303

A 70-year-old woman was recently diagnosed with essential hypertension and started on a medication to lower her blood pressure. She then stopped taking the medication as she reported ankle swelling. Her blood pressure readings usually run at 160/110 mmHg. She denies any headache, palpitation, chest pain, leg claudication or visual problems. She was diagnosed with osteoporosis with occasional back pain and has been admitted to the hospital for a hip fracture on two occasions over the last 3 years. There is no history of diabetes mellitus, coronary artery disease or stroke. She has no known drug allergy. Her vital signs are within normal limits, other than high blood pressure. The S1 is loud. The S2 is normal. There is an S4 sound without a murmur, rub or gallop. The peripheral pulses are normal and symmetric. The serum electrolytes (sodium, potassium, calcium and chloride), creatinine and urea nitrogen are within normal range.
What is the most appropriate antihypertensive medication for this patient?

MSFinals-0304

A 75-year-old man presents to his General Practitioner with chest pain. The man reports the pain as crushing in nature, exacerbated by exertion, particularly when climbing stairs in his home. The pain is typically relieved by rest, but he has experienced several episodes while watching television in the past two weeks. He has no other medical history and is generally in good health.
What is the most suitable course of action?

MSFinals-0305

At 15 years of age a boy develops rheumatic fever. Thirty-five years later, he is admitted to hospital with weight loss, palpitations, breathlessness and right ventricular hypertrophy. On examination he is found to have an audible pan systolic murmur.
Which heart valve is most likely to have been affected following rheumatic fever?

MSFinals-0306

A 28-year-old man comes to the clinic complaining of intermittent sharp central chest pains over the past 48 hours. The pain worsens with exertion and when he lies down. He reports no difficulty breathing. The ECG reveals widespread ST elevation.
What is the most probable diagnosis?

MSFinals-0281

A 68-year-old man presents with severe epigastric pain and nausea. He reports not having a bowel movement in 3 days, despite normal bowel habits prior to this. The patient has a history of coronary stents placed after a heart attack 10 years ago. He has been asymptomatic since then and takes aspirin for his cardiac condition and NSAIDs for knee arthritis. He has not consumed alcohol in the past 5 years due to a previous episode of acute gastritis.

On examination, there is mild tenderness over the epigastrium but no guarding. Bowel sounds are normal. An erect CXR and abdominal X-ray are unremarkable. Blood gases and routine blood tests (FBC, U&E, LFTs) are normal, with a normal amylase. Upper GI endoscopy reveals gastric erosions.

What is the most important differential diagnosis to consider for this patient?

MSFinals-0282

A 25-year-old man visits his general practitioner (GP), as he is concerned that he may have inherited a heart condition. He is fit and well and has no history of any medical conditions. However, his 28-year-old brother has recently been diagnosed with hypertrophic cardiomyopathy (HCM) after collapsing when he was playing football. The patient’s father died suddenly when he was 42, which the family now thinks might have been due to the same condition.
Which of the following signs is most likely to be found in a patient with this condition?

MSFinals-0283

A 60-year-old man with hypertension and hypercholesterolaemia experienced severe central chest pain lasting one hour. His electrocardiogram (ECG) in the ambulance reveals anterolateral ST segment elevation. Although his symptoms stabilized with medical treatment in the ambulance, he suddenly passed away while en route to the hospital.
What is the probable reason for his deterioration and death?

MSFinals-0284

A 66-year-old patient with a history of heart failure is given intravenous fluids while on the ward. You receive a call from a nurse on the ward reporting that the patient is experiencing increasing shortness of breath. Upon examination, you order an urgent chest X-ray.
What finding on the chest X-ray would be most indicative of pulmonary edema?

MSFinals-0285

A 67-year-old woman was admitted to the hospital after collapsing while shopping. During her inpatient investigations, she underwent cardiac catheterisation. The results of the procedure are listed below, including oxygen saturation levels, pressure measurements, and end systolic/end diastolic readings at various anatomical sites.

– Superior vena cava: 75% oxygen saturation, no pressure measurement available
– Right atrium: 73% oxygen saturation, 6 mmHg pressure
– Right ventricle: 74% oxygen saturation, 30/8 mmHg pressure (end systolic/end diastolic)
– Pulmonary artery: 74% oxygen saturation, 30/12 mmHg pressure (end systolic/end diastolic)
– Pulmonary capillary wedge pressure: 18 mmHg
– Left ventricle: 98% oxygen saturation, 219/18 mmHg pressure (end systolic/end diastolic)
– Aorta: 99% oxygen saturation, 138/80 mmHg pressure

Based on these results, what is the most likely diagnosis?

MSFinals-0286

A 27-year-old man comes to the clinic complaining of headache, dizziness, and claudication. Upon measuring his blood pressure, it is found that he has hypertension in his upper limbs and hypotension in his lower limbs. What other finding is most likely to be present in this case?