Archives: Medical Student Finals

MSFinals-5893

You are asked to see a 35-year-old man with a three year history of recurrent episodes of asymmetrical joint pains involving his knees, ankles and elbows. Two to four joints tend to be affected at any one time and each joint may be affected from two to four weeks each time.

In the last decade he has also had recurrent painful mouth sores. On this occasion, he also complains of a severe occipital headache, mild abdominal pain and some discomfort on passing urine.

On examination, his temperature is 38°C. His left knee and right ankle joints are painful, swollen and tender. Superficial thrombophlebitis is noted in the right leg.

Investigations show:

Hb 99 g/L (130-180)

WCC 11.6 ×109/L (4-11)

Platelets 420 ×109/L (150-400)

ESR 60 mm/hr (0-15)

Plasma sodium 138 mmol/L (137-144)

Plasma potassium 4.3 mmol/L (3.5-4.9)

Plasma urea 6.9 mmol/L (2.5-7.5)

Plasma creatinine 95 µmol/L (60-110)

Plasma glucose 5.8 mmol/L (3.0-6.0)

What is the most likely diagnosis?

MSFinals-5898

A 65-year-old woman complains of bilateral knee pain that has persisted for 4 months, despite taking paracetamol PRN. Her recent knee X-rays reveal moderate degenerative changes, and she has requested physiotherapy. What additional treatment should be initiated while waiting for physiotherapy?

MSFinals-5891

A 33-year-old woman presents to the hospital with recent-onset renal impairment after experiencing sinusitis. Upon chest X-ray, multiple cavitating lung lesions are discovered. The medical team suspects granulomatosis with polyangiitis (GPA). What is the most effective blood test to confirm this diagnosis?

MSFinals-5895

A 78-year-old retired general practitioner (GP) has been experiencing increasing swelling and tenderness of the right knee. Symptoms have been progressively worsening over four days. There is no history of trauma, and he has had no similar symptoms previously. The patient suspects that he may have pseudogout of the knee.
What is the most common tissue for calcium pyrophosphate crystal deposition in patients with pseudogout?

MSFinals-5890

A 45-year-old patient is referred for investigation of hypertension. On examination, she has a beaked nose and telangiectasia on the face. There is evidence of tight, waxy skin of the fingers, with calcification on one finger. She has had Raynaud’s disease for many years.
Which of the following autoantibodies is most likely to be positive?

MSFinals-5894

A 25-year-old male immigrant from Turkey presents with complaints of recurrent painful oral ulcers, genital ulcers, tender nodules on the extensor surface of the tibia and arthritis of both knees and ankles for the past 3 months. He has also had episodes of severe eye pain. He had an episode of pulmonary embolism due to deep vein thrombosis of the right leg 1 month ago. On examination, the oral cavity shows the presence of small shallow ulcers with a yellow necrotic centre. Genital examination reveals ulcers on the shaft of the penis and scrotal scars. The glans is spared. Non-specific inflammatory response is observed after intradermal injection of normal saline. Investigations revealed:
Investigation Result Normal value
White cell count (WCC) 20 × 109/l 4–11 × 109/l
Erythrocyte sedimentation rate (ESR) 80 mm/h 0–10mm in the 1st hour
C-reactive protein (CRP) Positive
Anti-Saccharomyces cerevisiae antibodies Positive
Which one of the following is the most likely diagnosis?

MSFinals-5892

A 50-year-old woman with a history of rheumatoid arthritis is experiencing shortness of breath during light activity and has developed a dry cough. Upon testing, her oxygen saturation was found to be 87% while breathing normally. A chest x-ray revealed a diffuse bilateral interstitial infiltrate. Despite an extensive infection screening, no infections were found, leading doctors to believe that her symptoms are a result of a drug she is taking. Which medication is the most likely culprit for this adverse reaction?

MSFinals-5900

A 68-year-old man visits his doctor’s office, reporting a recent onset of a red, swollen, and hot great left toe. He denies any injury to the toe and has a medical history of hypertension, which is being treated with a single medication. The doctor suspects acute gout as the diagnosis.
What medication is most likely responsible for triggering the acute gout?

MSFinals-5888

A 65-year-old woman presents with a one-month history of non-specific malaise. She reports stiffness, particularly in the mornings, and difficulty lifting her arms to comb her hair. She experiences constant aching in her arms and shoulders and jaw pain when chewing. She has also 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, her temperature is 38°C, pulse is 84 beats/min, and BP is 125/80 mmHg. Investigations reveal abnormal blood results. What is the most appropriate next step in her evaluation?

MSFinals-5899

A 50-year-old woman presents to her General Practitioner with widespread pain for the past month. The pain radiates all over but is worse in her shoulders, neck and lower back. It tends to be worse in the mornings and in cold weather. She reports that she is not able to sleep and feels lethargic during the day. Her partner reports that she has been more forgetful recently. She has otherwise been well without recent illnesses. On examination, there is clear tenderness to the affected areas. There are no other significant findings.
Which of the following is an appropriate first-line treatment for this patient?