Archives: Medical Student Finals

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-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?

MSFinals-6779

A 32-year-old obese man presents to Accident and Emergency with a 2-day history of nausea, frank haematuria and sharp, persistent left-sided flank pain, radiating from the loin to the groin. On examination, he has left renal angle tenderness.
Urine dip shows:
frank haematuria
blood 2+
protein 2+.
He has a history of hypertension, appendicitis 10 years ago and gout. You order a non-contrast computerised tomography (CT) for the kidney–ureter–bladder (KUB), which shows a 2.2 cm calculus in the proximal left (LT) ureter.
Which of the following is the definitive treatment for this patient’s stone?

MSFinals-6746

A 31-year-old woman complains of abdominal pain, nausea, and vomiting. An ultrasound scan reveals the presence of gallstones and an abnormal dilation of the common bile duct measuring 7 mm. The patient is currently taking morphine for pain relief. After four hours, the pain subsides, and she is discharged without any symptoms. Two weeks later, she returns for a follow-up visit and reports being symptom-free. What is the most appropriate next step in managing her condition?

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-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-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?

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-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?