Archives: Medical Student Finals

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-6183

A 32-year-old woman is being evaluated on the surgical ward due to complaints of abdominal pain and vomiting. She underwent a gallstone removal procedure earlier in the day. Her vital signs reveal a heart rate of 102 beats/min, blood pressure of 132/92 mmHg, temperature of 38.6ºC, oxygen saturation of 99% in room air, and respiratory rate of 20/min. Blood tests are ordered and a CT scan of the abdomen is requested. What is the probable diagnosis?

MSFinals-6184

A 55-year-old man comes to the emergency department complaining of right upper quadrant abdominal pain that has been ongoing for 2 days. He has a medical history of type 2 diabetes mellitus and excessive alcohol consumption. The patient denies having jaundice, pale stools, or dark urine.
An ultrasound of the biliary tree reveals no gallstones but shows some regional lymphadenopathy. Further imaging suggests that a branch of the biliary tree is being compressed extramurally.
Based on this information, where is the most likely location of the lesion?

MSFinals-6185

A 35-year-old motorcyclist is rushed to the emergency department after a high-speed road traffic accident. Upon examination, his pulse rate is 110/min, blood pressure is 100/74 mmHg, and his GCS is 15. X-rays reveal a closed but comminuted fracture of his left tibia, which is swollen and tender. As he is being transferred to the orthopaedic ward, he complains of severe, unrelenting pain in his left lower leg and numbness in his left foot. The dorsalis pedis and posterior tibial pulsations are palpable, but the pain in his foot worsens with passive dorsiflexion of the ankle. What is the most likely cause of this patient’s symptoms?

MSFinals-6186

A 30-year-old woman presents with a breast lump and is referred to secondary care. Imaging reveals ductal carcinoma in situ that is oestrogen receptor-positive, progesterone receptor-negative, and HER2-negative. The recommended treatment plan includes lumpectomy, adjuvant radiotherapy, and endocrine therapy. The patient has no medical history and does not use hormonal contraceptives. Her menstrual cycle is regular with a 28-day cycle. What is the mechanism of action of the drug that will likely be prescribed?

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?

MSFinals-6188

A 75-year-old male presents with complaints of brown coloured urine and abdominal distension. On examination, he displays signs of large bowel obstruction with tenderness in the central abdomen. The left iliac fossa is the most tender area. The patient is stable hemodynamically. What investigation should be performed?

MSFinals-6160

A 29-year-old man is in a car crash and experiences a flail chest injury. He arrives at the emergency department with hypotension and an elevated jugular venous pulse. Upon examination, his heart sounds are faint. What is the probable diagnosis?

MSFinals-6161

A 21-year-old motorcyclist is in a road traffic collision. His breathing is irregular. Upon examination, he has multiple rib fractures, including 2 fractures in the 3rd rib and 3 fractures in the 4th rib. What is the underlying condition?