Archives: Medical Student Finals

MSFinals-0287

A 48-year-old man presents to the Emergency Department with chest tightness. His blood pressure is 200/105 mmHg and heart rate is 70 bpm. His femoral pulses cannot be felt. Echocardiography reveals cardiomegaly and a left-ventricular ejection fraction of 34%. The patient also has a N-terminal pro-brain natriuretic peptide (NT-proBNP) of 25,000 pg/mL. As a result of the patient’s hypertension and high levels of NT-proBNP, he undergoes coronary angiography to exclude cardiac ischaemia. There is no evidence of myocardial ischaemia, but there are significant arterial findings.
Which of the following is most likely to be seen on coronary angiography of this patient?

MSFinals-0288

You are requested by a nurse to assess a 66-year-old woman on the Surgical Assessment Unit who is 1-day postoperative, having undergone a laparoscopic cholecystectomy procedure for cholecystitis. She has a medical history of type II diabetes mellitus and chronic kidney disease. Blood tests taken earlier in the day revealed electrolyte imbalances with hyperkalaemia.
Which of the following ECG changes is linked to hyperkalaemia?

MSFinals-0289

A 70-year-old man presents with severe breathlessness which started this morning and has become gradually worse. The patient denies coughing up any phlegm. He has a history of essential hypertension. On examination, the patient has a blood pressure of 114/75 mmHg and a respiratory rate of 30 breaths per minute. His temperature is 37.1°C. His jugular venous pressure (JVP) is 8 cm above the sternal angle. On auscultation there are fine bibasal crackles and a third heart sound is audible. The patient is an ex-smoker and used to smoke 5–10 cigarettes a day for about 10 years.
What is the most likely diagnosis?

MSFinals-0290

A 68-year-old man experienced acute kidney injury caused by rhabdomyolysis after completing his first marathon. He was started on haemodialysis due to uraemic pericarditis. What symptom or sign would indicate the presence of cardiac tamponade?

MSFinals-0291

A 60-year-old man is seen at cardiology outpatients 6 weeks after an anterior myocardial infarction. His wife complains that she cannot sleep at night due to his constant coughing and throat clearing.
Which medication is likely causing these symptoms?

MSFinals-0293

A 30-year-old woman visits her GP to discuss contraception options, specifically the combined oral contraceptive pill. She has no medical history, is a non-smoker, and reports no health concerns. During her check-up, her GP measures her blood pressure and finds it to be 168/96 mmHg, which is consistent on repeat testing and in both arms. Upon examination, her BMI is 24 kg/m2, her pulse is 70 bpm, femoral pulses are palpable, and there is an audible renal bruit. Urinalysis is normal, and blood tests reveal no abnormalities in full blood count, urea, creatinine, electrolytes, or thyroid function. What is the most conclusive test to determine the underlying cause of her hypertension?

MSFinals-0294

A 30-year-old woman visits her GP to discuss contraception options, specifically the combined oral contraceptive pill. She has no medical history, is a non-smoker, and reports no symptoms of ill-health. During her check-up, her GP measures her blood pressure and finds it to be 168/96 mmHg, which is consistent on repeat testing and in both arms. Upon examination, her BMI is 24 kg/m2, her pulse is 70 bpm, femoral pulses are palpable, and there is an audible renal bruit. Urinalysis is normal, and blood tests reveal no abnormalities in full blood count, urea, creatinine, electrolytes, or thyroid function. What is the most conclusive test to determine the underlying cause of her hypertension?

MSFinals-0296

A 55-year-old man is experiencing chest pain and shortness of breath three weeks after a myocardial infarction that was treated with percutaneous coronary intervention (PCI) for a proximal left anterior descending artery occlusion. On examination, he has a loud friction rub over the praecordium, bilateral pleural effusions on chest x-ray, and ST elevation on ECG. What is the most probable diagnosis?