Archives: Medical Student Finals

MSFinals-5962

A 65-year-old man visits his General Practitioner (GP) complaining of a swollen and painful first metatarsophalangeal joint that has been bothering him for a week. He reports that the pain became unbearable last night. The patient denies any fever or toe injuries. Upon examination, the joint appears red, swollen, and warm to touch. The patient has a history of gout, peptic ulcer, and is currently taking allopurinol 300 mg once a day for gout prophylaxis. What is the most appropriate next step in management?

MSFinals-5963

A 42-year-old known intravenous (iv) drug user presents to her general practitioner with complaints of fever, morning stiffness, and joint pain. The patient reports a constant, dull pain in the distal interphalangeal (DIP) joints bilaterally, with an intensity of 3/10. Her medical history is unremarkable, but her family history includes a skin condition and rheumatoid arthritis. The patient consumes 15 alcoholic units per week and smokes two packs of cigarettes per day. On physical examination, the patient is febrile with a temperature of 38.1 °C. The DIP joints are warm and swollen, and there is symmetric nail pitting. What is the most likely diagnosis for this patient’s current presentation?

MSFinals-5936

A 68-year-old woman presents with a one-month history of non-specific malaise. She experiences stiffness, particularly in the mornings, and has difficulty lifting her arms to comb her hair. She also has constant pain in her arms, shoulders, and jaw when chewing. She has lost 4 kg in weight and has a persistent headache. She smokes 10 cigarettes a day and drinks 10 units of alcohol per week. On examination, she has tenderness with reduced mobility in the proximal muscles of her arms and legs. Her investigations reveal a low Hb, high WCC, and elevated ESR. What is the most likely diagnosis?

MSFinals-5938

A 40-year-old farmer presents to the clinic with muscle pain in his lower back, calves and neck. He takes regular paracetamol but this has not helped his symptoms. For the past four weeks, he has become increasingly agitated and reports that he can no longer sleep for more than a few hours because the pain wakes him up. He feels increasingly lethargic and helpless. He also reports that as a result of his pain, he feels that his memory has worsened and he reports a low mood. A Kessler Psychological Distress Scale screening questionnaire is performed and he has a score of 30. His laboratory blood tests are unremarkable.
What is the most appropriate treatment for this patient?

MSFinals-5939

An 80-year-old man presents with complaints of stiffness and pain in both shoulders. He has experienced a weight loss of one stone over the past eight weeks and reports feeling lethargic with a decreased appetite. Upon investigation, a positive rheumatoid factor, normochromic normocytic anaemia, and a significantly elevated ESR (100 mm/hr) were found. What is the most probable diagnosis?

MSFinals-5940

A 27-year-old man presents to his primary care physician with complaints of worsening back pain and stiffness over the past 5 months. He denies experiencing leg pain, loss of bladder or bowel control, or weakness in his lower extremities. The patient reports that the stiffness in his back tends to improve throughout the day. Upon examination, the physician notes mild tenderness directly over the lumbar spine and decreased range of motion with hip flexion. The patient has normal muscle strength in his lower extremities and intact sensation. X-ray results reveal sacroiliitis, vertebral squaring, and a ‘bamboo spine’. Which of the following is most likely associated with this patient’s condition?

MSFinals-5941

A 25-year-old man with inflammatory bowel disease has been experiencing lower back pain, stiffness, and buttock pain for the past six months. He notices that his pain improves after playing squash on Saturdays. He has tested positive for HLA-B27 and his blood tests, including C-reactive protein and erythrocyte sedimentation rate, are normal except for a mild hypochromic microcytic anemia. What is the most likely diagnosis?

MSFinals-5942

A 32-year-old woman fell off her horse while horse-riding and is now experiencing severe foot pain. Her foot was trapped in the stirrup during the fall. An x-ray revealed displacement of her second and third metatarsal from the tarsus. What is the name of this injury?

MSFinals-5943

A 40-year-old school teacher who enjoys running long distances comes to the clinic complaining of cramp-like pain in the forefoot that has been bothering them for the past week. During the examination, tenderness was noted over the dorsal distal portion of the second metatarsal. What is the probable diagnosis?