Archives: Medical Student Finals

MSFinals-6172

A 60-year-old active builder presents to the emergency department with left-sided scrotal pain and swelling accompanied by fever for the past two days. He had a urinary tract infection 10 days ago, which improved after taking antibiotics. He has a medical history of benign prostatic hyperplasia and is waiting for transurethral resection of the prostate. Despite his age, he is still sexually active with his wife and denies ever having a sexually transmitted disease. What is the probable pathogen responsible for his current condition?

MSFinals-6173

A 50-year-old woman has been referred to the Surgical Assessment Unit by her doctor after an ultrasound scan revealed biliary dilation and subsequent imaging confirmed the presence of gallstones. She woke up this morning with severe pain in the right upper quadrant, accompanied by sweating and her husband noticed her skin appeared more yellow than usual. What is the probable diagnosis?

MSFinals-6174

A 65-year-old man presents to clinic with a three month history of worsening lower urinary tract symptoms and nocturnal enuresis. Upon examination, he has a painless distended bladder and a smoothly enlarged prostate on digital rectal examination. Bladder scan reveals 1.5L residual and ultrasound kidney, ureter, bladder (US KUB) shows bilateral hydronephrosis. His blood results are as follows:
Na+ 136 mmol/L (135 – 145)
K+ 4.5 mmol/L (3.5 – 5.0)
Bicarbonate 28 mmol/L (22 – 29)
Urea 6.5 mmol/L (2.0 – 7.0)
Creatinine 310 µmol/L (55 – 120)
What is the most likely diagnosis?

MSFinals-6175

You are a general practitioner and a 85-year-old woman presents with a complaint of severe itching in her left nipple. During examination, you observe that the nipple is red and there is some discharge with blood stains on her bra. What would be the best course of action for management?

MSFinals-6176

A 16-year-old male is brought to the emergency department (ED) after sustaining a head injury during a soccer game. According to his parents, he lost consciousness immediately after the collision for several minutes. He regained consciousness and was himself for a few hours, but they brought him to the ED when he became drowsy and complained of a headache. On examination, his Glasgow coma scale (GCS) is 12, his pupils are unequal, and there is a noticeable swelling on the right side of his head. Based on the probable diagnosis of an intracranial hemorrhage, which vessel is most likely damaged?

MSFinals-6177

A 68-year-old woman is referred to the 2-week wait breast clinic by her GP due to a lump in her left breast. After undergoing triple assessment, she is diagnosed with breast cancer that is positive for oestrogen receptors. The oncologist suggests initiating a medication that is designed to target this type of breast cancer, but only in women who have gone through menopause.

What is the medication that the oncologist might be referring to?

MSFinals-6143

A 55-year-old sheep farmer who recently arrived in the UK from Iran presents with increasing right upper quadrant (RUQ) pain of two week’s duration. She also complains of tiredness and of being generally unwell for several months. She has not experienced a change in her bowel habit, weight loss, or night sweats.

Upon examination, her temperature is 37.8ºC, heart rate 80/min, blood pressure 135/90 mmHg, respiratory rate 18/min. She is mildly jaundiced with RUQ pain and the liver edge is palpable 3 cm below the costal margin.

Blood tests revealed raised eosinophils and her LFTs were as follows:
– Bilirubin 30 µmol/l
– ALP 190 u/l
– ALT 36 u/l

An ultrasound scan of her liver demonstrated a 7 cm cystic lesion. The scan was technically challenging but there appeared to be daughter cysts present.

What is the recommended next investigation to carry out?

MSFinals-6152

A 55-year-old woman with ulcerative colitis and primary sclerosing cholangitis visits her GP complaining of colicky abdominal pain and pruritus that has persisted despite taking ursodeoxycholic acid. She also reports unintentional weight loss of 5kg over two months. During the examination, the patient appears mildly jaundiced and a mass is palpable in the right hypochondrium. What screening test can be performed to detect the probable malignancy?

MSFinals-6153

A 44-year-old woman arrives at the emergency department complaining of intense abdominal pain and nausea. She admits to having experienced several episodes of biliary colic in the past, particularly after consuming fatty foods, but never sought medical attention. What specific set of findings would prompt you to seek immediate senior evaluation?

MSFinals-6158

A 30-year-old man with a past medical history of chronic constipation complains of sudden perianal pain. The pain has been persistent for a week and worsens during bowel movements. Additionally, he reports observing a small amount of bright red blood on the toilet paper after wiping.
Upon examination, the abdominal region appears normal, but rectal examination is not feasible due to the patient’s discomfort.
What is the probable diagnosis?