Archives: Medical Student Finals

MSFinals-6147

A 55-year-old man with a recent diagnosis of prostate cancer is found to be positive for a BRCA2 mutation on genetic screening. He has a strong family history of prostate cancer, with both his father and uncle receiving treatment for the condition at a young age.

He is worried that he may have passed the gene onto his son and daughter. He is also concerned that his brother may have the gene, given their family history.

During counselling, what is the most appropriate statement to make regarding the risk of his family inheriting the BRCA2 gene?

MSFinals-6148

A 30-year-old man was admitted to the emergency department following a car crash. He was found to be in a profound coma and subsequently pronounced brain dead.

What is the accurate diagnosis in this case?

MSFinals-6149

A 75-year-old woman comes to the clinic with a painful swelling in her left breast. Despite receiving three rounds of antibiotics from her primary care physician over the past four weeks, the erythema and tenderness have not subsided. During the examination, there is noticeable redness and swelling in the breast, and a tender lump can be felt along with swollen lymph nodes in the armpit. What should be the next course of action in managing this patient’s condition?

MSFinals-6150

A 75-year-old woman undergoes a left hemicolectomy for colon cancer. The pathology report reveals that the tumour has invaded the muscle layer surrounding the colon but there is no lymph node involvement or distant metastasis on the CT scan of the abdomen and pelvis. What is the Dukes stage of the tumour in this patient?

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-6154

Mrs. Smith has recently been diagnosed with bowel cancer. Which marker would be most effective in monitoring the tumor’s progression and response to future treatment?

MSFinals-6156

A thirty-five-year-old man with ulcerative colitis is recovering on the ward 6 days following a proctocolectomy. During the morning ward round, he complains to the team looking after him that he has developed pain in his abdomen. The pain started in the left iliac fossa but is now diffuse. It came on suddenly, overnight, and has gradually been getting worse since. He ranks it 9/10. He has not opened his bowels or passed flatus since the procedure. He has had no analgesia for this.

On examination:

Blood pressure: 105/68 mmHg;
Heart rate: 118/minute, regular;
Respiratory rate: 12/minute;
Temperature: 38.2 ºC;
Oxygen saturations: 98%.

Abdominal exam: abdomen is distended and diffusely tender upon palpation and widespread guarding, indicating peritonism. No organomegaly or palpable abdominal aortic aneurysm. Kidneys are non-ballotable. No shifting dullness. Bowel sounds are absent.

There is 250 mL of feculent matter in the abdominal wound drain.

The registrar requests an abdominal CT which demonstrates an anastomotic leak. What is the most appropriate initial management of this patient?

MSFinals-6157

A 19-year-old man is brought into the emergency department after being involved in a motorcycle accident. He is minimally responsive, visibly pale, and groaning in pain.

Key findings from the initial A-E approach are:

Airway Patent
Breathing Chest clear and equal air entry bilaterally, respiratory rate 30 breaths per minute, oxygen saturation 95%
Circulation Heart rate 160 beats per minute, blood pressure 80/50 mmHg
Disability GCS 9/15, blood glucose 7 mmol/L, pupils equal and reactive to light
Everything else Tense abdomen with diffuse tenderness

You make several attempts at siting a cannula but fail.

What is the most appropriate next step in the management of this patient’s hypotension?