MSFinals-0841
Which of the following is the least likely to worsen bronchospasm in severe asthma?
Med Student Finals Category: Emergency Medicine
MSFinals-0842
A 16-year-old girl weighing approximately 70 kg is brought to the Emergency department in cardiac arrest. She was found collapsed at home surrounded by empty packets of amitriptyline 25 mg. The ambulance service reports that she had a weak pulse and no respiratory effort. She has been intubated and is being ventilated by bag-valve mask. The presenting rhythm is a sinusoidal supraventricular tachycardia with wide QRS complexes. Blood pressure is barely recordable but a weak carotid and femoral pulse are palpable.
Immediate arterial bloods gases are obtained and reveal an arterial pH of 6.99 (7.35-7.45), pO2 of 11.8 kPa (11.0-14.0), pCO2 of 5.9 kPa (4.5-6.0), HCO3- of 9.6 mmol/L (16-22), base excess of −19.7 mmol/L (-2 to +2), lactate of 7.4 mmol/L (0.5-2.0), potassium of 4.9 mmol/L (3.3-5.5), and glucose of 4.8 mmol/L (5.0-7.0).
What is the most appropriate next step?
MSFinals-0843
A 50-year-old runner experiences chest pain and collapses while jogging. He is brought to the Emergency department within an hour. Upon arrival, he is conscious and given a sublingual nitrate which provides some relief. His heart rate is 90 beats per minute and his blood pressure is 120/85 mmHg. An ECG reveals 3 mm of ST segment elevation in leads II, III, AVF, V5 and V6. What is the most appropriate next step in managing this patient?
MSFinals-0844
You are summoned to the assessment unit to evaluate a 65-year-old man who has been experiencing fevers and purulent green sputum for the past three days. He has no significant medical history and is not taking any regular medications. He is eager to return home as he is the primary caregiver for his ailing father.
During the examination, you observe that the patient is alert and oriented, but has bronchial breathing at the right base and a respiratory rate of 32 breaths per minute. His vital signs are as follows: HR 115 regular, BP 88/58 mmHg, O2 92% room air.
Initial blood tests reveal a WCC of 13.2 ×109/L (4-11) and urea of 8.5 mmol/L (2.5-7.5).
What is the most appropriate course of action?
MSFinals-0830
A 68-year-old man arrives at the emergency department with a 24-hour history of epigastric pain that radiates to his back and vomiting. The doctors diagnose him with pancreatitis after his serum amylase levels come back at 2000. They also run some additional blood tests and find the following results:
– WCC: 22 ×109/L (Neutrophils: 17.2)
– Hb: 155 g/L
– Urea: 18.2 mmol/L
– Creatinine: 105 μmol/L
– AST: 250 IU
– LDH: 654 IU
– Calcium: 2.3 mmol/L
– Albumin: 38 g/L
– Glucose: 7.5 mmol/L
– PaO2: 9.9 KPa
What is the Modified Glasgow score for this patient?
MSFinals-0831
A 65-year-old man has been brought to the hospital after collapsing at his workplace. Upon examination, he is found to be in a comatose state without response to visual stimuli, but he does extend his limbs in response to painful stimuli and occasionally makes incomprehensible sounds. His blood pressure is 164/88 mmHg, pulse rate is 98 beats per minute, and he exhibits hyperreflexia on the left side with bilateral extensor plantar responses. What is his Glasgow coma scale score?
MSFinals-0832
A 50-year-old man is brought to the hospital by the police after being found unconscious on the street. He appears disheveled and smells strongly of alcohol. Despite attempts to gather information about his medical history, none is available. Upon examination, his temperature is 35°C, blood pressure is 106/72 mmHg, and pulse is 52 bpm. He does not respond to commands, but when a venflon is attempted, he tries to grab the arm of the medical professional and makes incomprehensible sounds while keeping his eyes closed. What is his Glasgow coma scale score?
MSFinals-0833
A 57-year-old woman presents to the Emergency department with increasing lethargy. She has a history of drinking a bottle of vodka daily and has been experiencing persistent vomiting for the past week.
On examination, her pulse is 96/min and blood pressure is 109/70 mmHg. The following blood results are obtained:
– pH 7.32 (7.36-7.44)
– PaO2 12.0 kPa (11.3-12.6)
– PaCO2 3.1 kPa (4.7-6.0)
– Standard bicarbonate 10 mmol/L (20-28)
– Base excess −8 mmol/L (+/−2)
– Lactate 1.2 mmol/L (0.5-2.2)
– Sodium 142 mmol/L (137-144)
– Potassium 3.4 mmol/L (3.5-4.9)
– Urea 6.5 mmol/L (2.5-7.5)
– Creatinine 72 µmol/L (60-110)
– Plasma glucose 3.4 mmol/L (3.0-6.0)
– Urine analysis Ketones +++
What is the most appropriate treatment for this patient?
MSFinals-0834
A 75-year-old widower is brought to the Emergency department after being found collapsed at home. His wife passed away recently and he has been struggling with depression. He has a history of stable angina and takes atenolol for it.
During the examination, his blood pressure is 80/35 mmHg and he is bradycardic. His first and second heart sounds are audible, his oxygen saturation is 95%, and his chest is clear. The cardiac monitor shows a heart rate of 20 beats per minute, and the ECG shows a junctional escape rhythm without changes of ischaemia.
What would be the most appropriate initial intervention?
MSFinals-0835
A middle-aged homeless man in his early 50s is brought to the emergency department with a six hour history of profuse vomiting. He complains of nausea and headache.
The history available is sketchy. He is of no fixed abode and denies having any previous medical problems. He appears unkempt and is confused – oriented to person but not time or place. He is afebrile. His breath smells of ketones.
Twelve hours after admission his condition deteriorates. He complains of blurred vision and his pupils are fixed and dilated; his respiratory rate increases sharply over the next few minutes and he becomes unconscious.
Investigations show:
Hb 138 g/L (130-180)
WCC 7.1 ×109/L (4-11)
Platelets 401 ×109/L (150-400)
Plasma sodium 135 mmol/L (137-144)
Plasma potassium 5.0 mmol/L (3.5-4.9)
Plasma urea 5.8 mmol/L (2.5-7.5)
Plasma creatinine 110 µmol/L (60-110)
Plasma chloride 100 mmol/L (95-107)
Plasma bicarbonate 12 mmol/L (20-28)
Plasma glucose 5.5 mmol/L (3.0-6.0)
Plasma lactate 4.1 mmol/L (0.6-1.7)
PaO2 12 kPa (11.3-12.6)
PaCO2 4.2 kPa (4.7-6.0)
pH 7.22 (7.36-7.44)
Urine microscopy Crystals seen
What is the calculated anion gap in this case?