Med Student Finals Category: Emergency Medicine

MSFinals-0906

A 19-year-old male is admitted with acute asthma. He has been treated with steroid, bronchodilators and 15 l/min of oxygen.

His pulse rate is 125/min, oxygen saturation 89%, respiratory rate 24/min, blood pressure 140/88 mmHg and he has a peak flow rate of 150 l/min. On auscultation of his chest, he has bilateral wheezes.

Arterial blood gas (ABG) result taken on 15 l/min oxygen shows:

pH 7.42 (7.36-7.44)
PaO2 8.4 kPa (11.3-12.6)
PaCO2 5.3 kPa (4.7-6.0)
Standard HCO3 19 mmol/L (20-28)
Base excess −4 (+/-2)
Oxygen saturation 89%

What is the most appropriate action for this man?

MSFinals-0907

A 6-year-old boy is brought to the Emergency department by his mother who reports that he has put a small bead into his ear. Upon examination, you confirm the presence of a plastic bead lodged deep in the external canal of his left ear.

What is the best course of action in this situation?

MSFinals-0893

A 19-year-old male is brought to the Emergency department by a group of individuals who quickly leave before medical staff can speak with them. The patient is barely conscious, with a respiratory rate of 8/min, blood pressure of 120/70 mmHg, and a pulse of 60 bpm. Needle track marks are visible on his arms, and his pupils are constricted. What is the first treatment you would provide?

MSFinals-0894

A 48-year-old woman presented to the general medical clinic with a complaint of progressive diffuse myalgia and weakness that had been ongoing for three months. She reported experiencing difficulty walking up and down stairs due to weakness in her shoulder muscles and thighs. Her medical history included hypertension and hyperlipidemia, for which she took atenolol and simvastatin regularly. On examination, there were no abnormalities in the cranial nerves or detectable neck weakness. However, there was general myalgia in the upper limbs and proximal weakness of 3/5 with preserved distal power. A similar pattern of weakness was observed in the lower limbs with preserved tone, reflexes, and sensation.

The following investigations were conducted: haemoglobin, white cell count, platelets, ESR (Westergren), serum sodium, serum potassium, serum urea, serum creatinine, plasma lactate, serum creatine kinase, fasting plasma glucose, serum cholesterol, plasma TSH, plasma T4, and plasma T3. Urinalysis was normal.

Based on these findings, what is the likely diagnosis?

MSFinals-0895

A 20-year-old college student has ingested a mixture of over 100 paracetamol tablets and half a bottle of vodka after a disagreement with her partner. She has since vomited and has been rushed to the Emergency department in the early hours. It has been approximately six hours since she took the tablets. Her paracetamol level is 100 mg/L, which is above the normogram treatment line. Her test results show normal levels for sodium, potassium, glucose, INR, albumin, bilirubin, and alkaline phosphatase. Her urea and creatinine levels are slightly elevated. What is the most appropriate course of action?

MSFinals-0896

A 27-year-old male with a history of alcohol dependence and chronic hepatitis presents with reduced consciousness. He was discovered at home by a friend who reported that he had been depressed and threatening suicide.

Upon examination, the patient is found to be tachycardic and hypotensive, with a blood pressure of 90/60 mmHg. His Glasgow coma scale is 13/15, and there are no signs of jaundice or hepatomegaly. A plasma-paracetamol concentration of 70 mg/litre is detected.

What is the most appropriate course of action for this patient?

MSFinals-0897

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?

MSFinals-0898

A 25-year-old male presents to the Emergency department after being assaulted. He states that he was hit in the nose, resulting in swelling, deformity, and a small nosebleed. He also reports difficulty breathing through his left nostril. Upon examination, there is no active bleeding, but there is some deviation of the nasal bones to the left and no septal haematoma. What is the best course of action in this situation?

MSFinals-0899

A 57-year-old male presents with acute abdominal pain that has worsened over the past two hours. The pain originates in the epigastric region and radiates to the left side of his back, with colicky characteristics. He has vomited three to four times, with the vomit being greenish in color.

Upon examination, his temperature is 37.5°C, pulse is 100 beats per minute, and blood pressure is 114/80 mmHg. He has guarding of the abdomen and marked tenderness in the epigastrium. Bowel sounds are infrequent but audible.

Lab results show a neutrophilic leukocytosis, elevated glucose and urea levels, and an elevated creatinine level. Urinalysis reveals an elevated amylase level. Abdominal x-ray shows no abnormalities.

What is the likely diagnosis?

MSFinals-0900

A 23-year-old gardener experiences a sudden onset of breathlessness and right-sided chest pain while tending to the plants. He is quickly taken to the hospital, but his condition deteriorates during the examination conducted by a junior doctor.

The doctor notes a deviated trachea to the left and very faint breath sounds over the right lung. However, with the assistance of a senior doctor, the patient’s condition improves rapidly.

What is the likely diagnosis for this patient?