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?
Archives: Medical Student Finals
MSFinals-6771
A 68-year-old man tells his general practitioner that, for the past two months, he has been passing urine more often than usual and getting up at night to urinate. Given the man’s age, you suspect he might have symptoms related to an enlarged prostate.
Which of the following should be done first to confirm the first impression?
MSFinals-6768
A 30-year-old man presents with a left-sided, painless testicular lump. He has a history of orchidopexy for an undescended testicle.
On examination, there is a firm lump lying in the body of the left testicle. His body mass index is 27. There are a few left-sided inguinal lymph nodes palpable. You suspect testicular cancer.
Which of the following findings on history and examination makes this provisional diagnosis more likely?
MSFinals-6754
A 55-year-old man presents to the Emergency Department after vomiting bright red blood multiple times over the past four hours. He has a history of alcohol abuse and has been diagnosed with spontaneous bacterial peritonitis in the past. He currently consumes 4-5 pints of beer daily and has a poor compliance with his medication regimen, resulting in missed appointments and discharge from outpatient follow-up. On examination, he has dry mucous membranes, palmar erythema, and hepatomegaly. His vital signs are as follows: temperature 36.6°C, blood pressure 113/67 mmHg, respiratory rate 21 breaths per minute, heart rate 100 beats per minute, and SpO2 99% on room air. The patient is resuscitated with aggressive intravenous fluids, and the gastroenterology team is consulted. They suspect bleeding oesophageal varices and perform an upper gastrointestinal endoscopy, which confirms the diagnosis. The varices are banded, and bleeding is significantly reduced.
Which medication is most likely to prevent further episodes of oesophageal varices in this 55-year-old patient?
MSFinals-6759
A 45-year-old alcoholic presents to the Emergency Department with retrosternal chest pain, shortness of breath and pain on swallowing after a heavy drinking session the night before. He reports having vomited several times this morning, after which the pain started. He denies any blood in the vomit and has no melaena. On examination, he is febrile and tachypnoeic and has a heart rate of 110 bpm. A chest X-ray reveals a left-sided pneumothorax and air within the mediastinum.
Given the likely diagnosis, what is the most appropriate management to treat the underlying cause of his symptoms?
MSFinals-6762
A 54-year-old man with persistent dyspepsia was being evaluated at the nearby medical center. While performing oesophago-gastro-duodenoscopy (OGD), the endoscopist inserted the endoscope until it reached the oesophageal hiatus of the diaphragm.
At which vertebral level is it probable that the endoscope tip reached?
MSFinals-6747
A 32-year-old man presents with complaints of heartburn and epigastric pain that are affecting his daily routine. Upon endoscopy, a shallow ulcer is observed on the posterior aspect of the first part of the duodenum. Which artery is most likely to be eroded by the ulcer?
MSFinals-6753
A 56-year-old man comes to the Emergency Department with haematemesis. His friends report that he drank a large amount of alcohol earlier and had prolonged vomiting because he is not used to drinking so much. During the examination, his vital signs are: pulse 110 bpm, blood pressure 100/60 mmHg. There are no notable findings during systemic examination.
What is the most likely cause of the haematemesis in this case?
MSFinals-6760
A 67-year-old Indian woman presents to the Emergency Department with vomiting and central abdominal pain. She has vomited eight times over the last 24 hours. The vomit is non-bilious and non-bloody. She also reports that she has not moved her bowels for the last four days and is not passing flatus. She reports that she had some form of radiation therapy to her abdomen ten years ago in India for ‘stomach cancer’. There is no urinary urgency or burning on urination. She migrated from India to England two months ago. She reports no other past medical or surgical history.
Her observations and blood tests results are shown below:
Investigation Result Normal value
Temperature 36.9 °C
Blood pressure 155/59 mmHg
Heart rate 85 beats per minute
Respiratory rate 19 breaths per minute
Sp(O2) 96% (room air)
White cell count 8.9 × 109/l 4–11 × 109/l
C-reactive protein 36 mg/l 0–10 mg/l
The patient’s urine dipstick is negative for leukocytes and nitrites. Physical examination reveals a soft but distended abdomen. No abdominal scars are visible. There is mild tenderness throughout the abdomen. Bowel sounds are hyperactive. Rectal examination reveals no stool in the rectal vault, and no blood or melaena.
Which of the following is the most likely diagnosis?
MSFinals-6755
A 45-year-old woman comes to the Surgical Admissions Unit complaining of colicky abdominal pain and vomiting in the right upper quadrant. The pain started while eating but is now easing. During the examination, she appears restless and sweaty, with a pulse rate of 100 bpm and blood pressure of 125/86. An abdominal ultrasound reveals the presence of gallstones.
What is the most frequent type of gallstone composition?