Archives: Medical Student Finals

MSFinals-6200

A 72-year-old male comes to the Emergency Department during your night shift complaining of severe pain and discoloration in his right leg. He reports feeling pins and needles in the same leg, and the pain is present even when he is at rest. Upon examination, you notice that his right foot is pale, cold, and painful to the touch. You cannot feel any palpable pedal pulses. The patient has a medical history of ischaemic heart disease, chronic obstructive pulmonary disease, diabetes mellitus, and is a current smoker. What initial investigation should be performed to aid in the diagnosis?

MSFinals-6189

A 58-year-old accountant undergoes a transurethral resection of the prostate (TURP) that lasted for 45 minutes. The ST2 notifies you that the patient is restless. His heart rate is 100 bpm, and his blood pressure is 160/95 mmHg. He is experiencing fluid overload, and his blood test shows a sodium level of 122 mmol/l. What is the probable reason for these symptoms?

MSFinals-6193

You are shadowing a registrar on the pediatric ward, who is asked to help their consultant confirm a suspected case of brain stem death.
Which of the following would the doctors be assessing for?

MSFinals-6194

A 61-year-old man undergoes a laparotomy for bowel obstruction. On postoperative day 2, while walking in the hallway he experiences a sudden sharp pain and tearing sensation in his lower abdomen. Physical examination of the abdomen reveals separated wound margins with a tiny gaping area and splitting of the sutures in the lower half of the incision. His vital measurements indicate a blood pressure of 130/80 mmHg, and a heart rate of 96 beats per minute.

What is the best initial step in managing this patient?

MSFinals-6178

A 26-year-old male is brought in after a motorcycle accident. According to the paramedic, the patient has suffered a significant loss of blood due to an open femoral fracture, which has been reduced, and a haemothorax. The patient’s blood pressure is 95/74 mmHg, and his heart rate is 128 bpm. Although conscious, the patient appears confused. What is the stage of haemorrhagic shock that this patient is experiencing?

MSFinals-6179

A 68-year-old man complains of severe pain in his calves after walking his dog for only 10 minutes. Upon examination, his lower limbs appear normal except for the absence of posterior tibial and dorsalis pedis pulses. He has a history of myocardial infarction three years ago and is a heavy smoker, consuming 30 cigarettes per day. What medication should be prescribed daily for secondary prevention of cardiovascular disease, given the likely diagnosis?

MSFinals-6180

A 58-year-old male presents to the emergency department with a sudden and severe occipital headache accompanied by two episodes of vomiting within the last hour. Despite a normal CT scan, a lumbar puncture taken 12 hours later reveals xanthochromia, leading to a diagnosis of subarachnoid hemorrhage (SAH). Urgent neurosurgical consultation is requested, and a CT cerebral angiography confirms a posterior communicating artery aneurysm as the underlying cause of the SAH. The patient is otherwise healthy. What is the most suitable treatment option for the aneurysm?

MSFinals-6181

A 75-year-old man presents with fatigue. His complete blood count and iron studies are provided below.

Hemoglobin: 95g/L (normal range: 135-180g/L)
Mean Corpuscular Volume: 58fL (normal range: 78-100fL)
Platelets: 210* 109/L (normal range: 150-400* 109/L)
White Blood Cells: 7* 109/L (normal range: 4-11* 109/L)
Ferritin: 14 ug/L (normal range: 41-400 ug/L)
Total Iron Binding Capacity: 80 micromoles/L (normal range: 45-66 micromoles/L)

What is the most appropriate next investigation?

MSFinals-6182

A 50-year-old woman is admitted to the general surgery ward and a nurse has requested a review. The patient underwent a laparoscopic cholecystectomy due to biliary colic. During assessment, the patient presents with visible jaundice and complains of intermittent right upper quadrant pain that radiates to her back. Her vital signs are stable, and she is not febrile. Laboratory results show elevated bilirubin levels, ALP, and γGT. Based on these findings, what is the most likely diagnosis?

MSFinals-6187

A 32-year-old woman presents to her GP with concerns about the appearance of her legs. She has noticed visible, twisted veins on both legs for several years, which she finds unattractive. Although she experiences occasional itching, she does not feel any pain, and there has been no bleeding or swelling. She has no medical history or family history and does not take any regular medication.

Upon examination, the doctor observes dilated, twisted, superficial veins in both legs. There is no tenderness or swelling, and no skin changes, bleeding, or ulcers are visible.

What is the most appropriate management for this likely diagnosis?