Archives: Medical Student Finals

MSFinals-5814

A 62-year-old teacher visits her GP as she has noticed that she is becoming increasingly breathless whilst walking. She has always enjoyed walking and usually walks 5 times a week. Over the past year she has noted that she can no longer manage the same distance that she has been accustomed to without getting breathless and needing to stop. She wonders if this is a normal part of ageing or if there could be an underlying medical problem.
Which of the following are consistent with normal ageing with respect to the respiratory system?

MSFinals-5815

A 55-year-old smoker is referred by his General Practitioner (GP) for diagnostic spirometry after presenting with worsening respiratory symptoms suggestive of chronic obstructive pulmonary disease (COPD).
Regarding spirometry, which of the following statements is accurate?

MSFinals-5816

A 25-year-old man has suffered a left-sided pneumothorax. A chest drain has been inserted through the left fifth intercostal space at the mid-axillary line.
As well as the intercostal muscles, which other muscle is likely to have been pierced?

MSFinals-5817

A 70-year-old man with a medical history of hyperlipidaemia and hypertension arrives at the Emergency Department complaining of cough and difficulty breathing that has been getting worse over the past 24 hours. Upon examination, he is not running a fever, has a blood pressure of 100/60 mmHg, a heart rate of 110 bpm, and an oxygen saturation level of 95% on room air. During chest auscultation, the patient displays fine crackles in both lung bases. Additionally, a new audible systolic murmur is detected at the apex.

What is the most likely cause of the patient’s pulmonary symptoms?

MSFinals-5818

A 14-year-old male is brought in with acute severe asthma. During examination, it is noted that his peripheral pulse volume decreases during inspiration. What is the most probable reason for this clinical finding?

MSFinals-5819

A 35-year-old woman with a history of asthma and eczema visits her General Practitioner and inquires about the reason for her continued wheezing hours after being exposed to pollen. She has a known allergy to tree pollen.
What is the most suitable explanation for this?

MSFinals-5820

A 68-year-old retired caretaker with a well-documented history of chronic obstructive pulmonary disease (COPD) is admitted, for his fourth time this year, with shortness of breath and a cough productive of green sputum. Examination findings are: respiratory rate (RR) 32 breaths/min, temperature 37.4 °C, SpO2 86% on room air, asterixis and coarse crepitations at the left base. A chest X-ray (CXR) confirms left basal consolidation.
Which arterial blood gas (ABG) picture is likely to belong to the above patient?

MSFinals-5821

A 50-year-old man in the United Kingdom presents with fever and cough. He smells strongly of alcohol and has no fixed abode. His heart rate was 123 bpm, blood pressure 93/75 mmHg, oxygen saturations 92% and respiratory rate 45 breaths per minute. Further history from him reveals no recent travel history and no contact with anyone with a history of foreign travel.
Chest X-ray revealed consolidation of the right upper zone.
Which of the following drugs is the most prudent choice in his treatment?

MSFinals-5822

A 62-year-old man who is a smoker presents with gradual-onset shortness of breath, over the last month. Chest radiograph shows a right pleural effusion.
What would be the most appropriate next investigation?

MSFinals-5823

A 50-year-old woman is admitted to hospital with fever, dyspnoea and consolidation at the left lower base. She is commenced on antibiotics. A few days later, she deteriorates and a chest X-ray reveals a large pleural effusion, with consolidation on the left side.
What is the most important investigation to perform next?