Archives: Medical Student Finals

MSFinals-0246

A 63-year-old man presents with increasing shortness of breath on exertion. On examination, bibasilar wet pulmonary crackles are noted with mild bilateral lower limb pitting oedema. His jugular vein is slightly distended. An S4 sound is audible on cardiac auscultation. An electrocardiogram (ECG) shows evidence of left ventricular (LV) hypertrophy. Chest radiography shows bilateral interstitial oedema without cardiomegaly.
Which one of the following findings is most likely to be found in this patient?

MSFinals-0247

A 75-year-old man comes to the clinic with a complaint of experiencing severe dizziness upon standing quickly. He is currently taking atenolol 100 mg OD for hypertension. Upon measuring his blood pressure while lying down and standing up, the readings are 146/88 mmHg and 108/72 mmHg, respectively. What is the main cause of his postural hypotension?

MSFinals-0248

A 38-year-old intravenous (IV) drug user presents with pyrexia (39.8 °C) and general malaise. On examination, you identify a pansystolic murmur at the lower left sternal edge. You also notice that he has vertical red lines running along his nails and he tells you that he has been experiencing night sweats.
What is the most likely diagnosis?

MSFinals-0249

A 60-year-old woman received a blood transfusion of 2 units of crossmatched blood 1 hour ago, following acute blood loss. She reports noticing a funny feeling in her chest, like her heart keeps missing a beat. You perform an electrocardiogram (ECG) which shows tall, tented T-waves and flattened P-waves in multiple leads.
An arterial blood gas (ABG) test shows:
Investigation Result Normal value
Sodium (Na+) 136 mmol/l 135–145 mmol/l
Potassium (K+) 7.1 mmol/l 5–5.0 mmol/l
Chloride (Cl–) 96 mmol/l 95–105 mmol/l
Given the findings, what treatment should be given immediately?

MSFinals-0250

A 27-year-old intravenous drug user presents with a systolic murmur that is most audible at the fifth costal cartilage on the left sternal edge. What is the most probable anatomical site of the disease causing the murmur?

MSFinals-0251

A 28-year-old woman presents to the Emergency department with sudden onset of palpitations. Upon examination, her pulse rate is found to be 180 bpm and she appears warm and well perfused. Her blood pressure is 135/80 mmHg, respiratory rate is 20/min, and oxygen saturation is 100% on air. Chest auscultation reveals no signs of cardiac failure, but an ECG shows a narrow complex tachycardia. Despite attempts at carotid massage and Valsalva manoeuvre, the rhythm disturbance persists. What is the appropriate initial management?

MSFinals-0252

A 63-year-old diabetic woman presents with general malaise and epigastric pain of 2 hours’ duration. She is hypotensive (blood pressure 90/55) and has jugular venous distension. Cardiac workup reveals ST elevation in leads I, aVL, V5 and V6. A diagnosis of high lateral myocardial infarction is made, and the patient is prepared for percutaneous coronary intervention (PCI).
Blockage of which of the following arteries is most likely to lead to this type of infarction?

MSFinals-0253

A 50-year-old man with hypertension and type II diabetes mellitus presented to the Emergency Department with diaphoresis, severe central chest pain, and breathlessness. An ECG showed ST elevation in leads II, III, and aVF. Where is the probable location of the responsible arterial stenosis?

MSFinals-0255

A 50-year-old man with atrial fibrillation visited the Cardiology Clinic for electrophysiological ablation. What is the least frequent pathological alteration observed in atrial fibrillation?