Archives: Medical Student Finals

MSFinals-0203

A 61-year-old man experiences persistent, intense chest pain that spreads to his left arm. Despite taking multiple antacid tablets, he finds no relief. He eventually seeks medical attention at the Emergency Department and is diagnosed with a heart attack. He is admitted to the hospital and stabilized before being discharged five days later.
About three weeks later, the man begins to experience a constant, burning sensation in his chest. He returns to the hospital, where a friction rub is detected during auscultation. Additionally, his heart sounds are muffled.
What is the most likely cause of this complication, given the man’s medical history?

MSFinals-0204

A 62-year-old woman is being evaluated on the medical ward due to increasing episodes of dyspnoea, mainly on exertion. She has been experiencing fatigue more frequently over the past few months. Upon examination, she exhibits slight wheezing and bilateral pitting ankle oedema. Her medical history includes type I diabetes, rheumatoid arthritis, hypertension, recurrent UTIs, and hypothyroidism. Her current medications consist of insulin, methotrexate, nitrofurantoin, and amlodipine. She has never smoked, drinks two units of alcohol per week, and does not use recreational drugs. Blood tests reveal a haemoglobin level of 152 g/l, a white cell count of 4.7 × 109/l, a sodium level of 142 mmol/l, a potassium level of 4.6 mmol/l, a urea level of 5.4 mmol/l, and a creatinine level of 69 µmol/l. Additionally, her N-terminal pro-B-type natriuretic peptide (NT-proBNP) level is 350 pg/ml, which is higher than the normal value of < 100 pg/ml. What is the most probable diagnosis?

MSFinals-0205

A 67-year-old, diabetic man, presents to the Emergency Department with central crushing chest pain which radiates to his left arm and jaw. He has experienced several episodes of similar pain, usually on exercise. Increasingly he has found the pain beginning while he is at rest. A diagnosis of angina pectoris is made.
Which branch of the coronary arteries supplies the left atrium of the heart?

MSFinals-0206

A 56-year-old, 80 kg woman arrives at the Emergency Department complaining of chest pain that began 5 hours ago. She has no known allergies and is not taking any regular medications. Her electrocardiogram shows T-wave inversion in lateral leads but no ST changes, and her serum troponin level is significantly elevated. What is the appropriate combination of drugs to administer immediately?

MSFinals-0207

A 56-year-old Caucasian man presents to his General Practitioner (GP) for routine health screening. He has a background history of obesity (BMI 31 kg/m2), impaired glucose tolerance and he used to smoke. His blood pressure is 162/100 mmHg. It is the same in both arms. There is no renal bruit and he does not appear cushingoid. He does not take regular exercise. At his previous appointment his blood pressure was 168/98 mm/Hg and he has been testing his BP at home. Average readings are 155/95 mmHg. He does not drink alcohol. His father had a heart attack at age 58. Blood results are listed below:
Investigation Result Normal value
HbA1C 46 mmol/l < 53 mmol/mol (<7.0%)
Potassium 4.1 mmol/l 3.5–5 mmol/l
Urea 7 mmol/l 2.5–6.5 mmol/l
Creatinine 84 µmol/l 50–120 µmol/l
Total cholesterol 5.2 mmol/l < 5.2 mmol/l
High-density lipoprotein (HDL) 1.1 mmol/l > 1.0 mmol/l
Low density-lipoprotein (LDL) 3 mmol/l < 3.5 mmol/l
Triglycerides 1.1 mmol/l 0–1.5 mmol/l
Thyroid Stimulating Hormone (TSH) 2 µU/l 0.17–3.2 µU/l
Free T4 16 pmol/l 11–22 pmol/l
What is the most appropriate next step in management of this patient?

MSFinals-0208

An overweight 56-year-old Caucasian male patient attends for the results of a health check arranged by your surgery. He smokes 12 cigarettes a day and is trying to cut down. Alcohol intake is 8 units per week. He tells you that his father underwent a ‘triple bypass’ aged 48 years. His results are as follows:
Total cholesterol : HDL ratio 6
HbA1c: 39 mmol/mol
Urea and electrolytes: normal
Estimated glomerular filtration rate (eGFR): 97 ml/min/1.73m2
Liver function tests: normal
Blood pressure (daytime average on 24-h ambulatory monitor): 140/87
Body mass index (BMI): 25
His QRISK2 10-year cardiovascular risk is calculated at 22.7%.

In addition to assisting with smoking cessation and providing lifestyle advice, what is the most appropriate means of managing his risk?

MSFinals-0209

A 72-year-old man is admitted to hospital with exertional chest pain. He reports that this has only begun in the past few days, particularly when climbing hills. The pain is not present when he is at rest.
What is the gold standard test that you will request for this patient from the following tests?

MSFinals-0210

A 50-year-old man undergoes a workplace medical and has an ECG performed. What is the electrophysiological basis of the T wave on a typical ECG?

MSFinals-0211

A 65 year old man with a BMI of 29 was diagnosed with borderline hypertension during a routine check-up with his doctor. He is hesitant to take any medications. What dietary recommendations should be given to help lower his blood pressure?

MSFinals-0212

A 68-year-old woman presents to the hospital with complaints of shortness of breath, extreme weakness, and epigastric pain that started 30 minutes ago while she was using the restroom. She is still experiencing these symptoms and is sweating profusely. Her heart rate is 150 bpm, and her blood pressure is 180/110 mmHg. An ECG is ordered, which shows elevated ST segments in consecutive leads and Q waves. What is the most probable cause of this woman’s condition?