Archives: Medical Student Finals

MSFinals-0297

A 65-year-old woman presents to the Emergency Department with chest pain that has worsened over the past 2 days. She also reported feeling ‘a little run down’ with a sore throat a week ago. She has history of hypertension and hyperlipidaemia. She reports diffuse chest pain that feels better when she leans forward. On examination, she has a temperature of 37.94 °C and a blood pressure of 140/84 mmHg. Her heart rate is 76 bpm. A friction rub is heard on cardiac auscultation, and an electrocardiogram (ECG) demonstrates ST segment elevation in nearly every lead. Her physical examination and blood tests are otherwise within normal limits.
Which of the following is the most likely aetiology of her chest pain?

MSFinals-0298

A 57-year-old male with a history of hypertension for six years presents to the Emergency department with complaints of severe chest pain that radiates to his back, which he describes as tearing in nature. He is currently experiencing tachycardia and hypertension, with a blood pressure reading of 185/95 mmHg. A soft early diastolic murmur is also noted. The ECG shows ST elevation of 2 mm in the inferior leads, and a small left-sided pleural effusion is visible on chest x-ray. Based on the patient’s clinical history, what is the initial diagnosis that needs to be ruled out?

MSFinals-0299

You are called to see a 62-year-old man who has suddenly deteriorated after pacemaker insertion. He has sudden-onset shortness of breath and is cold and clammy. On examination, his blood pressure is 90/50 mmHg, pulse 100 bpm and regular. His jugular venous pressure (JVP) is markedly elevated and his heart sounds are muffled. You give him oxygen and plasma volume expanders intravenously (iv).
Which of the following is the next most appropriate intervention?

MSFinals-0300

A 32-year-old woman with shortness of breath on exercise comes to the clinic some 6 months after the birth of her second child. The recent pregnancy and post-partum period were uneventful. Her general practitioner has diagnosed her with asthma and prescribed a salbutamol inhaler. On examination, she looks unwell and is slightly short of breath at rest. Her blood pressure is 150/80 mmHg and her body mass index (BMI) is 24. There is mild bilateral pitting ankle oedema. Auscultation of the chest reveals no wheeze.
Investigations
Investigation Result Normal value
Haemoglobin 129 g/l 115–155 g/l
White cell count (WCC) 5.8 × 109/l 4–11 × 109/l
Platelets 190 × 109/l 150–400 × 109/l
Sodium (Na+) 140 mmol/l 135–145 mmol/l
Potassium (K+) 4.8 mmol/l 3.5–5.0 mmol/l
Creatinine 110 µmol/l 50–120 µmol/l
Electrocardiogram (ECG) Right axis deviation,
incomplete right bundle branch block
Pulmonary artery systolic pressure 33 mmHg
Which of the following is the most likely diagnosis?

MSFinals-0261

A 35-year-old woman presents to her Accident and Emergency with visual loss. She has known persistently uncontrolled hypertension, previously managed in the community. Blood tests are performed as follows:
Investigation Patient Normal value
Sodium (Na+) 148 mmol/l 135–145 mmol/l
Potassium (K+) 2.7 mmol/l 3.5–5.0 mmol/l
Creatinine 75 μmol/l 50–120 µmol/
Chloride (Cl–) 100 mEq/l 96–106 mEq/l
What is the next most appropriate investigation?

MSFinals-0262

A 30-year-old man presents with syncope, which was preceded by palpitations. He has no past medical history and is generally fit and well. The electrocardiogram (ECG) shows a positive delta wave in V1.
Which of the following is the most likely diagnosis?

MSFinals-0263

Which congenital cardiac defect is correctly matched with its associated syndrome from the following options?

MSFinals-0264

A 72-year-old man has been hospitalized with crushing chest pain. An ECG trace shows ischaemia of the inferior part of the heart. What is the term that best describes the artery or arterial branch that provides blood supply to the inferior aspect of the heart?

MSFinals-0265

A 16-year-old boy is discovered following a street brawl with a stab wound on the left side of his chest to the 5th intercostal space, mid-clavicular line. He has muffled heart sounds, distended neck veins, and a systolic blood pressure of 70 mmHg. What is the most accurate description of his condition?

MSFinals-0266

A 66-year-old patient visits her General Practitioner (GP) with complaints of chest pain and shortness of breath when climbing stairs. She reports no other health issues. During the examination, the GP notes a slow-rising pulse, a blood pressure reading of 130/100 mmHg, and detects a murmur on auscultation.
What is the most probable type of murmur heard in this patient?