Archives: Medical Student Finals

MSFinals-5967

A 35-year-old male executive presents to you after being referred from the Emergency department. He has been experiencing a painful and swollen left knee for the past 24 hours. He denies any history of joint problems or trauma. Additionally, he has noticed redness and soreness in both eyes over the last two days. He is a non-smoker, married, and consumes about 10 units of alcohol weekly. He recently returned from a business trip to Amsterdam two weeks ago.

During examination, his temperature is 38.5°C, and he has a brown macular rash on the soles of his feet. His left knee is hot, swollen, and tender to palpate, while no other joint appears to be affected.

Investigations reveal Hb 129 g/L (130-180), WBC 14.0 ×109/L (4-11), Platelets 200 ×109/L (150-400), ESR 75 mm/hr (0-15), Plasma sodium 140 mmol/L (137-144), Plasma potassium 4.1 mmol/L (3.5-4.9), Plasma urea 5.6 mmol/L (2.5-7.5), Blood cultures without growth after 48 hours, and Urinalysis without blood, glucose, or protein detected. Knee x-ray shows soft tissue swelling around the left knee.

What is the most likely diagnosis?

MSFinals-5970

A 32-year-old woman has been experiencing a burning sensation on passing urine with frequency for the past two days, and she also has some lower abdominal pain. She has no unusual vaginal discharge and denies any recent sexual contact. This is the first time she has experienced anything like this.
She is a non-smoker and a well-controlled asthmatic on regular inhalers (daily beclomethasone and salbutamol as needed) but has no other medical problems or medication apart from the oral combined contraceptive pill.
On examination her heart rate is 85 beats per minute, blood pressure 110/70 mmHg, and temperature 36.8°C.
Abdominal examination – soft abdomen, no guarding, mildly tender hypogastric region, active bowel sounds.
Urinalysis:
Leukocytes –
Nitrites ++
Blood +
Bilirubin –
Protein +
Glucose –
Ketones –

What is the most likely diagnosis in this patient?

MSFinals-5980

After fertilisation, which part of the spermatozoon remains in the cytoplasm of the oocyte?

MSFinals-5965

A 79-year-old woman, with a history of recurrent falls, had a recent fall on her outstretched right hand. An X-ray revealed a fracture of the distal radius with volar displacement. She has multiple risk factors for osteoporosis, and a DEXA scan was requested. What score is indicative of a diagnosis of osteoporosis?

MSFinals-5975

A 20-year-old student visits the Genitourinary Medicine (GUM) Clinic with concerns about a recent sexual encounter. He had unprotected sex with a woman and has since developed a purulent urethral discharge and painful urination. Gram-negative diplococci were identified in specimens taken from him. What is the probable causative organism for this patient’s symptoms?

MSFinals-5966

A 38-year-old woman with a 12-year history of rheumatoid arthritis is admitted with a ‘flare’. She is a familiar patient to the ward and has previously been prescribed methotrexate, gold and sulphasalazine. The last two medications were effective for the first two years but then became less helpful even at higher doses. She is currently taking oral steroids.
On examination: there is active synovitis in eight small joints of the hands and the left wrist.
What is the most appropriate next course of treatment for this patient?

MSFinals-5977

You review a 35-year-old woman with a history of menorrhagia and dysmenorrhoea. She has started a new relationship and wants some advice on the best method of contraception.
An ultrasound scan from six months ago showed three subserosal fibroids ranging in size from 1 to 2 cm in maximal dimension, without uterine distortion.
Her medical history includes migraines with aura, which are well controlled at present.
Which of the following is the best suited method of contraception for this patient?

MSFinals-5982

A 30-year-old man presents to the Genitourinary Medicine (GUM) Clinic with a rash. Upon examination, the doctor observes numerous flesh-colored, hemispherical papules with a central indentation, measuring around 4 mm in diameter, covering the upper thighs and shaft of the penis. The diagnosis is molluscum contagiosum. What would be a suitable treatment plan for this patient?

MSFinals-5974

A teenage patient has been diagnosed with a chlamydial infection following a recent sexually transmitted infection (STI) screen. The patient has agreed to treatment of the infection and has no known allergies, however, you are concerned about compliance.
Which of the following would be most appropriate?

MSFinals-5976

You are investigating the mechanisms of action of the currently available treatments for the human immunodeficiency virus (HIV).
Regarding HIV, which of the following statements is accurate?