Archives: Medical Student Finals

MSFinals-6780

A 35-year-old healthy man presents because he and his wife have been repeatedly unsuccessful in achieving pregnancy, even after three years of actively attempting to conceive. They are not using any method of contraception. The wife has been tested and determined to be fertile. The husband’s past medical history is significant for being treated for repeated upper respiratory tract infections and ear infections, as well as him stating ‘they told me my organs are all reversed’. He also complains of a decreased sense of smell. His prostate is not enlarged on examination. His blood test results are within normal limits.
Which of the following is the most likely cause of the patient’s infertility?

MSFinals-6788

A 54-year-old man visits his GP clinic, reporting discomfort in his scrotum. During the examination, the doctor notices an abnormality on the right side of the scrotum that feels like a bag of worms. The patient mentions that this has only been present for the past two months and there is no change in the examination when he lies down. What is the recommended next step?

MSFinals-6781

A 65-year-old man presents with a gradual reduction in urine flow. His prostate-specific antigen (PSA) is found to be 14.3 ng/ml (normal PSA level: 2.5-4.0 ng/mL).
What is the most important investigation required?

MSFinals-6797

A 30-year-old man presents with left scrotal discomfort and a feeling of tightness. Upon examination, there is mild swelling of the left scrotum with varices resembling a bag of worms in the overlying skin that appears dark red. Scrotal ultrasound confirms the presence of a varicocele on the left side. Which structure is most likely dilated in this patient?

MSFinals-6785

A 72-year-old man is recovering from hip surgery on the ward. He has had an indwelling catheter for several days. In the last 24 hours, he has been noted to have some ‘dizzy spells’ by nurses where he becomes confused and agitated. He has been seen talking to himself, mumbling incoherent ideas, and at other times he seems distracted and disorientated, forgetting where he is. He has a new fever and is tachycardic. The rest of the examination is unremarkable. You suspect he is suffering from delirium.
Which one of the following is most likely to be found in this patient?

MSFinals-6784

A 16-year-old arrives at the Emergency Department with sudden and severe pain in his groin while playing basketball. He has no significant medical history and denies any trauma to the area. During the exam, he experiences persistent pain in his right testicle when it is raised. An ultrasound with Doppler reveals reduced blood flow in the right testicle. Which artery is most likely occluded in this patient?

MSFinals-6777

A 42-year-old man presents to his General Practitioner with a 6-month history of erectile dysfunction. He also reports that he has noticed galactorrhoea and is experiencing headaches, usually upon waking in the morning. He has no significant past medical history. His blood test results are as follows:
Investigation(s) Result Normal range
Haemoglobin (Hb) 142 g/l 130–180 g/l
White cell count (WCC) 5.0 × 109/l 3.5–11 × 109/l
Sodium (Na+) 138 mmol/l 135–145 mmol/l
Potassium (K+) 4.1 mmol/l 3.5–5.3 mmol/l
Thyroid-stimulating hormone (TSH) 3.8 mU/l 0.27-4.2 mU/l
Prolactin 5234 mU/l 86-324 mU/l
Which of the following further investigations should be requested?

MSFinals-6776

A 68-year-old man presents to the Urology Clinic with a 4-month history of difficulty initiating micturition and poor flow when passing urine. He reports waking up 2-3 times a night to urinate and has not experienced any changes in bowel habits. He denies any visible blood in his urine and is generally feeling well. There is no family history of prostate cancer. During digital rectal examination (DRE), a slightly enlarged and smooth prostate is detected. Urinalysis shows protein + but is negative for blood, ketones, glucose, nitrites, and leukocytes. Full blood count, urea and electrolytes, and liver function tests all come back normal. His prostate-specific antigen (PSA) level is 1.3 ng/ml. What is the most appropriate management plan?

MSFinals-6763

A 50-year-old man arrived at the Emergency Department with massive haematemesis. An emergency endoscopy revealed a bleeding gastric ulcer located on the lesser curvature of the stomach. Which vessel is most likely affected?

MSFinals-6778

A 70-year-old man with a history of hypertension presents to his general practitioner after discovering a mass in his scrotum. He reported feeling a heavy, dragging sensation in his scrotum for approximately 2 weeks before noticing the mass during self-examination. Upon examination, the patient had a palpable, non-tender mass on the right side of the scrotum, seemingly associated with the right testicle. Ultrasound of the scrotum revealed dilation of the right pampiniform plexus.
What is the most probable cause of this patient’s condition?