Archives: Medical Student Finals

MSFinals-6701

A patient in their mid-40s is transferred from a District General Hospital to the Burns and Trauma Centre. They arrive intubated. The history is that they were on some scaffolding holding a pole, which they touched onto an overhead powerline, causing electrocution. They fell backwards and were found to be in ventricular fibrillation (VF) arrest by paramedics, who resuscitated them with defibrillation. They have small burns on their hands and also their left foot. On arrival at the Trauma Centre, they have a full CT traumagram which showed no other injuries. Their C-spine has been radiologically cleared. You are examining them, and you notice they have a swollen, tight left leg. The nurse brings you their blood gas, and you see they have a potassium level of 6.3 and they have mild metabolic acidaemia, with a pH of 7.21. Their urine is tea-coloured (catheter in situ), with a creatine kinase (CK) level of 1232.
What is the best course of action?

MSFinals-6703

A 48-year-old woman is brought to the Emergency Department following a motor vehicle accident. The patient’s car was parked in the street when a small car hit her vehicle from behind. She was seated and restrained in the driver’s seat and was not ejected from the vehicle. The airbags did not deploy. The ambulance staff reported that the patient did lose consciousness at the scene but now is alert and orientated.
Her primary and secondary surveys are normal. Her neurological examination is also normal and she has full cervical spine range of motion. The patient has a Glasgow Coma Scale of 15/15.
Her observations and blood tests results are shown below.
Temperature 36.9 °C
Blood pressure 121/59 mmHg
Heart rate 67 beats per minute
Respiratory rate 18 breaths per minute
Sp(O2) 98% (room air)
Her computed tomography (CT) scan of the head, cervical spine, chest, abdomen and pelvis is normal. She is still complaining of diffuse, muscular pain throughout her body which was not present before the accident. She is able to mobilise slowly around the ward. She states that prior to the accident she was able to mobilise independently without difficulty and without pain.
Which of the following is the most likely diagnosis?

MSFinals-6704

A young patient is brought to the Emergency Department following a car accident and presents with the following symptoms:
respiratory rate 15 bpm
pulse 70 bpm
blood pressure 120/80
Glasgow Coma Score 3/15
nasal bleeding mixed with clear fluid
orbital haematoma (‘raccoon eyes’)
no other facial bruising.
What is the probable cause of the patient’s injuries?

MSFinals-6708

A 23-year-old man was stabbed with a knife and brought to the Emergency Department, with the knife still in the left posterolateral side of his body. The knife entered the intercostal space between the left ninth and tenth ribs, 10 cm posterior to the mid-axillary line.
What is the most likely structure to have been damaged first by the knife?

MSFinals-6706

A 30-year-old previously healthy man is involved in an accident at work. He is brought to the Emergency Department where he is found to have superficial abrasions to the left side of chest and upper abdomen together with an obvious deformity of the left humerus. Radiograph of the left arm shows a displaced, midshaft humerus fracture. Neurovascular examination reveals radial nerve palsy together with absent peripheral pulses and a cool, clammy distal arm. He was given oral paracetamol at work while waiting for the ambulance to arrive. Pain score remains 9/10. Parameters are as follows:
Patient Normal
Temperature 36.8°C 36.1–37.2°C
Pulse 115 beats/min 60–100 beats/min
Blood pressure 145/93 mmHg <120/80 mmHg
Oxygen saturations 99% on room air 94–98%
Respiratory rate 24 breaths/min 12–18 breaths/min
Which of the following is the most appropriate form of pain relief?

MSFinals-6699

A 28-year-old man is involved in a bicycle accident and is thrown from his bike. He suffers an injury to his left shoulder that results in bruising. The left side of his neck and left shoulder are tender and painful. Upon examination of his left upper limb, there is a loss of external rotation and abduction at the shoulder, as well as a loss of flexion of the elbow and supination of the forearm. Cutaneous sensation testing reveals numbness on the lateral aspect of the arm, forearm, and hand. What is the most likely neurological structure that has been damaged?

MSFinals-6697

A 72-year-old man with a history of smoking and high blood pressure arrives at the Emergency Department complaining of sudden-onset abdominal pain. He reports that the pain is severe and radiates to his back. Upon examination, a pulsatile mass is detected in his abdomen. The patient is currently stable and able to communicate without difficulty. The medical team suspects an abdominal aortic aneurysm (AAA).
Which layers of the abdominal aortic wall are expected to be dilated in this patient?

MSFinals-6696

A 25-year-old victim of a high-speed car collision had a right sided pneumothorax, along with fracture of the pelvis and right humerus. A chest drain was inserted, which kept on bubbling over the next few days. The air leak got worse when the drain was connected to low-grade suction and the lung failed to expand fully.
What is the most likely cause of this complication?

MSFinals-6700

A 94-year-old man is admitted to hospital after a fall at home. He reports pain in his right groin when moving and is unable to put weight on his leg, despite taking regular full-dose paracetamol and codeine. Although his pain is well managed when he is at rest, he feels drowsy from the pain relief. An X-ray of his hip and pelvis has revealed no apparent cause for his discomfort. What is the most suitable course of action for managing this patient?

MSFinals-6698

A 19-year-old man playing rugby injures his right arm, resulting in swelling and tenderness in the cubital fossa. Upon examination, it is found that the patient’s ability to flex his elbow is reduced and his ability to supinate his right forearm is significantly impaired. However, sensation in the skin of his right forearm remains intact. What structure is most likely to have been damaged?