Med Student Finals Category: Emergency Medicine

MSFinals-0887

A 25-year-old male presents with wheezing and a respiratory rate of 35/min, a pulse of 120 beats per min, blood pressure 110/70 mmHg, and a peak expiratory flow rate of less than 50% predicted. He has received back-to-back nebulisers of salbutamol 5 mg and ipratropium 0.5 mg for the past 45 minutes and is currently on face mask oxygen. Additionally, he has been given hydrocortisone 100 mg IV, and the intensive care team has been notified.

An arterial blood gas test was performed on high-flow oxygen, revealing a pH of 7.42 (7.36-7.44), PaCO2 of 5.0 kPa (4.7-6.0), PaO2 of 22 kPa (11.3-12.6), base excess of -2 mmol/L (+/-2), and SpO2 of 98.

What is the recommended next step in therapy for this patient?

MSFinals-0888

A 25-year-old asthmatic has been feeling unwell for the past day, experiencing a productive cough, fever, and occasional wheezing. Despite using his regular salbutamol inhaler, his shortness of breath has been worsening, prompting him to seek medical attention at the hospital.

After being assessed by a colleague, the patient has received four rounds of back-to-back salbutamol nebulisers, one round of ipratropium nebulisers, and intravenous hydrocortisone. However, the patient’s condition is deteriorating, with increasing respiratory rate and speaking in words only. His chest is now silent, and his oxygen saturation is at 90% despite receiving 10 litres of oxygen.

What is the next recommended therapeutic intervention for this patient?

MSFinals-0889

A 49-year-old man has been brought into Accident and Emergency, after being rescued from a fire in his home by firefighters. He has extensive burns across most of his torso and lower limbs; however, on assessment, his airway is patent and he currently has a Glasgow Coma Scale (GCS) score of 11. Paramedics have already been able to gain bilateral wide-bore access in both antecubital fossae. He weighs approximately 90 kg, and estimates from the paramedics are that 55% of his body is covered by burns, mostly second-degree, but with some areas of third-degree burns. His observations are:
Temperature 36.2 °C
Blood pressure 102/73 mmHg
Heart rate 112 bpm
Saturations 96% on room air
Respiratory rate 22 breaths/min
What would be the most appropriate initial method of fluid resuscitation?

MSFinals-0874

A 65-year-old patient has just been administered intravenous ceftazidime. Suddenly, the patient experiences flushing and wheezing, and their blood pressure drops to 80/40 mmHg. What is the most suitable immediate action to take for this patient?

MSFinals-0890

A 50-year-old male presents with sudden onset of severe headache accompanied by vomiting and photophobia. Upon examination, the patient appears distressed with a temperature of 37.5°C and a Glasgow coma scale of 15/15. His blood pressure is 146/88 mmHg. The patient exhibits marked neck stiffness and photophobia, but neurological examination is otherwise normal. What is the suspected diagnosis?

MSFinals-0875

A 56-year-old woman who underwent Hartmann’s procedure six hours ago has started to complain of abdominal pain and light-headedness. On assessment, she has a blood pressure of 80/40 mmHg, a heart rate of 120 bpm, a respiratory rate of 22 breaths per minute, oxygen saturations of 98% and a temperature of 36.7 °C. She appears drowsy and pale, and the radial pulse is difficult to detect. Her abdomen appears rigid and is painful to palpate, and a bleed is suspected.
What type of shock is this patient most likely to have?

MSFinals-0891

A 22-year-old woman is discovered by her roommates in a confused, drowsy, and sweaty state in her bedroom. She is unable to provide a clear medical history. Upon examination, she has a fever of 38.3°C, a heart rate of 110 bpm, a blood pressure of 110/60 mmHg, and appears to be short of breath with a respiratory rate of 30. There is no stiffness in her neck, and her chest sounds clear upon auscultation. An arterial blood gas test taken with 15 l/min oxygen shows a pH of 7.29 (7.35-7.45), Pa O2 of 37 kPa (11-14), PaCO2 of 2.1 kPa (4.5-6), and lactate of 2.4 mmol/L (0.1-2.5). What is the most probable diagnosis?

MSFinals-0876

A 65-year-old man experiences a bout of memory loss. He had a moment of confusion three days prior, during which his wife guided him inside and offered him tea. Despite being conscious and able to converse with his wife, he wandered around the house in a confused state and repeatedly asked the same questions. After three hours, he suddenly returned to his normal state and had no memory of the incident. What is the probable diagnosis?

MSFinals-0892

A 25-year-old law student presents with visual loss in the right eye, accompanied by a constant headache for the past three months. She also reports not having had her menstrual cycle for six months. Upon examination, her visual acuity in the affected eye is 6/24, with slight constriction of both temporal visual fields. However, there are no other neurological deficits present. The patient is stable, without fever or hemodynamic abnormalities. What is the likely diagnosis?

MSFinals-0861

A previously healthy 85-year-old woman presents to the surgical admissions unit after being referred by her GP due to a two-day history of increasing pain and swelling in the right groin area. Upon examination, there is a firm and red swelling that extends from the pubic tubercle downwards and outwards. What is the probable diagnosis?