Med Student Finals Category: Emergency Medicine

MSFinals-0928

A 70-year-old patient with type 2 diabetes and stable ischaemic heart disease presents with palpitations lasting for 4 days. The patient is currently taking metformin 500 mg tds, aspirin 75 mg daily, ramipril 2.5 mg daily, and simvastatin 40 mg daily. Upon examination, the patient’s pulse rate is 140/minute and blood pressure is 128/98 mmHg. There is no chest pain or evidence of acute heart failure, but the ECG confirms atrial fibrillation. What is the most appropriate treatment for managing the patient’s atrial fibrillation?

MSFinals-0929

As the orthopaedic foundation year doctor, you have been requested by the nurse in charge to assess a patient who is experiencing acute shortness of breath and right-sided chest pain 8 days after undergoing total knee replacement surgery. The patient is a 66-year-old builder with a medical history of COPD and high cholesterol. He has a BMI of 35 and currently smokes 30 cigarettes per day. His vital signs are as follows: regular heart rate of 115 beats per minute, blood pressure of 135/60 mmHg, and oxygen saturation of 91% on room air. What is the most effective diagnostic test to perform on this patient?

MSFinals-0930

A 63-year-old male presents with a sudden onset of double vision that has been ongoing for eight hours. He has a medical history of hypertension, which is managed with amlodipine and atenolol, and type 2 diabetes that is controlled through diet. Upon examination, the patient displays watering of the right eye, a slight droop of the eyelid, and displacement of the eye to the right. The left eye appears to have a full range of movements, and the pupil size is the same as on the left. What is the probable cause of his symptoms?

MSFinals-0931

A 16-year-old boy comes to the emergency department after taking 60 of his father’s fluoxetine tablets about four hours ago.

Which of the following symptoms is consistent with his reported ingestion?

MSFinals-0932

A 54-year-old female presents with a five day history of fever, cough and malaise. She recently returned from a holiday in southern Spain and has since developed a non-productive cough with chills that have worsened. The patient has a history of smoking 10 cigarettes per day but no other medical history. On examination, she has a temperature of 40°C, blood pressure of 118/72 mmHg, and a pulse of 106 bpm. Chest examination reveals inspiratory crackles at the left base only, with a respiratory rate of 28/min. Baseline investigations show haziness at the left base on CXR, Hb 128 g/L (115-165), WCC 5.5 ×109/L (4-11), Platelets 210 ×109/L (150-400), Sodium 130 mmol/L (137-144), Potassium 3.8 mmol/L (3.5-4.9), Creatinine 100 µmol/L (60-110), Urea 5.2 mmol/L (2.5-7.5), and Glucose 5.5 mmol/L (3.0-6.0). What is the most likely diagnosis?

MSFinals-0909

A 33-year-old male presents to the Emergency department with complaints of severe chest pain that has been ongoing for an hour. Upon examination, he is tall and slim with a blood pressure reading of 135/80 mmHg and an early diastolic murmur. The electrocardiogram reveals 1 mm ST elevation in II, III, and aVF. What is the best course of action in this situation?

MSFinals-0925

A 42-year-old male presents to the Emergency department after tripping on a rocky trail during a hike. He has scrapes on both shins and a heavily soiled deep wound on his right palm. An x-ray of his hand reveals the existence of a foreign object. The patient reports being up-to-date on his tetanus immunization (last vaccination 5 years ago). What measures should be taken in this situation?

MSFinals-0910

A nervous 23-year-old man with a rapid breathing rate presents with the following arterial blood gas findings:
pH 7.27 (7.36-7.44)
PCO2 2.6 KPa (4.7-6.0)
Base excess −12 mmol/L
What is his acid-base status?

MSFinals-0926

A 55-year-old accountant presents with weight loss and excessive sweating. Upon examination, she is found to be clinically thyrotoxic with a diffuse goitre. The following investigations were conducted: Free T4 levels were found to be 40 pmol/L (normal range: 9-23), Free T3 levels were 9.8 nmol/L (normal range: 3.5-6), and TSH levels were 6.1 mU/L (normal range: 0.5-5). What would be the most appropriate next step in the diagnostic process?

MSFinals-0911

What vitamin is utilized to treat confusion in individuals with chronic alcoholism?