Archives: Medical Student Years 1-3

MS-4902

Brenda is a 36-year-old woman who presents with tachypnoea. This occurred whilst she was seated. Her only medical history is asthma for which she takes salbutamol. On examination, her respiratory rate is 28 breaths/minute, heart rate 100bpm, Her chest is resonant on percussion and lung sounds are normal. Her chest X-ray is normal. You obtain her arterial blood gas sample results which show the following:

pH 7.55
PaCO2 4.2 kPa
PaO2 10 kPa
HCO3 24 mmol/l

What could have caused the acid-base imbalance in Brenda’s case?

MS-4907

A 70-year-old man with lung cancer is having a left pneumonectomy. The left main bronchus is being divided. Which thoracic vertebrae is located behind this structure?

MS-4906

Which one of the following muscles is supplied by the external laryngeal nerve?

MS-4905

A 78-year-old man comes to your clinic with a complaint of hoarseness in his voice for the past 2 months. He is unsure if he had a viral infection prior to this and has attempted using over-the-counter remedies with no improvement. How would you approach managing this patient?

MS-4901

A 65-year-old man presents with a persistent dry cough and unintentional weight loss of 5kg over the past 3 months. He denies experiencing chest pain, dyspnoea, fever or haemoptysis. The patient has a history of smoking 10 cigarettes a day for the last 50 years and has been diagnosed with COPD. A nodule is detected on chest x-ray, and biopsy results indicate a tumour originating from the bronchial glands.

What is the most probable diagnosis?

MS-4904

A 65-year-old man visits his doctor complaining of a productive cough and difficulty breathing for the past 10 days. The doctor prescribes antibiotics, but after a week, the patient’s symptoms persist and he develops a fever and pain when breathing in. The doctor orders a chest x-ray, which indicates the presence of an empyema. What is the probable causative agent responsible for this condition?

MS-4903

A 20-year-old male arrives at the emergency department with a sudden worsening of his asthma symptoms. He is experiencing difficulty in speaking and breathing, with cyanosis of the lips and a respiratory rate of 33 breaths per minute. He reports feeling lightheaded. Although his airways are open, his chest sounds are faint upon auscultation. The patient is administered oxygen, nebulized salbutamol, and intravenous aminophylline.

What is the mechanism of action of aminophylline?

MS-4900

A 65-year-old patient presents at the lung cancer clinic for their initial assessment. Their general practitioner referred them due to a persistent cough lasting 5 months and a weight loss of one stone in a month. The patient has quit smoking recently but used to smoke 20-30 cigarettes daily for 30 years. No asbestos exposure is reported.

A circular lesion was detected in the right upper lobe during a recent chest x-ray. A subsequent computed tomography (CT) scan indicated that this lung lesion is indicative of a primary lesion.

What is the most probable sub-type of lung cancer in this case?

MS-4899

A 35-year-old female smoker presents with acute severe asthma.

The patient’s SaO2 levels are at 91% even with 15 L of oxygen, and her pO2 is at 8.2 kPa (10.5-13). There is widespread expiratory wheezing throughout her chest.

The medical team administers IV hydrocortisone, 100% oxygen, and 5 mg of nebulised salbutamol and 500 micrograms of nebulised ipratropium, but there is little response. Nebulisers are repeated ‘back-to-back,’ but the patient remains tachypnoeic with wheezing, although there is good air entry.

What should be the next step in the patient’s management?

MS-4898

A 27-year-old man with a history of epilepsy is admitted to the hospital after experiencing a tonic-clonic seizure. He is currently taking sodium valproate as his only medication. A venous blood gas is obtained immediately.

What are the expected venous blood gas results for this patient?