Archives: Medical Student Finals

MSFinals-5981

A 35-year-old woman presents to her primary care physician seeking the combined oral contraceptive pill (COCP). She has a history of pelvic inflammatory disease and had an ectopic pregnancy that was treated with methotrexate a year ago. Additionally, she is a heavy smoker, consuming 20 cigarettes per day. Her family history is significant for BRCA1 mutation in her mother and sister, but she declines genetic testing. What would be an absolute contraindication for the COCP in 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-5957

A 35-year-old man presents to the outpatient department with complaints of lower back pain. He used to be an active soccer player but has had to give up due to the pain.

During the examination, there is no skin rash or history of gastrointestinal or genitourinary symptoms. The patient reports difficulty standing straight and walking in a stooped position for hours each morning before being able to stand up straight. Additionally, there is redness and pain around the right heel, and Schober’s test is positive.

What abnormalities may be found on the patient’s ECG?

MSFinals-5951

A 35-year-old nun is seen in the Rheumatology Clinic every year for her long-standing seropositive arthritis affecting her hands, knees, and hips. Her arthritis is linked to another chronic condition she also experiences.

MSFinals-5959

A 63-year-old woman visits her GP complaining of pain and swelling in her fingers and wrists. The pain has been gradually worsening over the past few months, and she is having difficulty opening jars at home. She reports that her fingers are stiff when she wakes up but gradually loosen throughout the morning.

Upon examination, the GP notes symmetrical swelling of the MCP and PIP joints, which are tender to pressure and have stress pain on passive movement. The patient also has swan neck and boutonnière deformities of the fingers. The GP diagnoses the patient with rheumatoid arthritis and refers her to a rheumatologist. The GP prescribes anti-inflammatory medications and advises the patient to rest her fingers and wrists.

What is the most common ocular extra-articular manifestation of rheumatoid arthritis in a patient who is 63 years old?

MSFinals-5952

A 30-year-old science teacher is diagnosed with tenosynovitis of the fingers of the left hand, although she is not experiencing any tenderness or swelling of the affected fingers.
In which one of the following conditions can tendinitis/tenosynovitis present without being swollen and tender?

MSFinals-5958

A 68-year-old woman who has suffered many years from aggressive rheumatoid arthritis presents for review. Most recently, she has suffered from two severe respiratory tract infections (which have been treated with oral clarithromycin) and has had worsening left upper quadrant pain. She currently takes low-dose prednisolone for her rheumatoid. On examination, there are obvious signs of active rheumatoid disease. Additionally, you can feel the tip of her spleen when you ask her to roll onto her right-hand side.
Investigations:
Investigation Result Normal value
Haemoglobin 91 g/l 115–155 g/l
White cell count (WCC) 1.9 × 109/l (neutrophil 0.9) 4–11 × 109/l
Platelets 90 × 109/l 150–400 × 109/l
Rheumatoid factor +++
Erythrocyte sedimentation rate (ESR) 52 mm/h 0–10mm in the 1st hour
Which of the following is the most likely diagnosis in this case?

MSFinals-5955

A 35-year-old woman presents with increasing early-morning bilateral knee pain and stiffness and generalised fatigue. On examination, she is noted to have flat erythema over the malar eminences with sparing of the nasolabial folds. Multiple painless oral ulcers are also noted. Examination of the knee joints reveals tenderness and suprapatellar effusions bilaterally.
Which of these is most specific for the underlying condition?

MSFinals-5956

A 58-year-old woman has been scheduled for a left total knee replacement in one month’s time. She has a past medical history significant for rheumatoid arthritis (RA), for which she takes methotrexate and hydroxychloroquine.
Which of the following investigations would be most important before the patient’s operation?

MSFinals-5953

What is the most probable diagnosis for a 70-year-old woman who presents with bilateral shoulder pain and stiffness, fatigue, weight loss, and elevated ESR levels?