Archives: Medical Student Finals

MSFinals-5253

A 68-year-old man is brought to the Emergency department after being hit by a cricket ball on his left cheek while watching a game. He remained conscious and is alert and oriented with a GCS of 15/15, but he feels nauseous, disoriented, and experiences significant pain at the site of impact. His vital signs are stable, and there are no abnormalities found during cardiorespiratory or neurological examination.

The patient has a medical history of type 2 diabetes and depression and takes aspirin 75 mg OD, metformin 850 mg TDS, sitagliptin 100 mg OD, ramipril 5 mg OD, and venlafaxine 75 mg BD. A CT scan of the brain reveals a fracture of the left zygomatic arch, and he is referred to maxillofacial surgery. The medical team administers 100 mg IV tramadol for pain relief.

However, two minutes later, the patient experiences a prolonged tonic-clonic seizure, requiring intubation and transfer to ITU. Which of the patient’s regular medications should be avoided when using tramadol?

MSFinals-5254

A 46-year-old man comes in for a follow-up visit after beginning rate control therapy for his atrial fibrillation. He reports no instances of palpitations, dizziness, or fainting. During the examination, his pulse is irregularly irregular with a heart rate of 82 beats per minute. He feels that his atrial fibrillation is well-managed, but he has noticed a change in his bowel movements since starting the treatment and has experienced difficulty passing stools. What is the most probable rate control medication he is taking?

MSFinals-5255

A 32-year-old woman presents with severe vomiting to the Emergency Department. She was given a course of antibiotics a few days earlier (amoxicillin and metronidazole) for a sinus infection. You understand that she has had a few glasses of wine earlier in the day for a family gathering.
Investigations: Urine 2+ blood, no protein
Investigation Result Normal value
Haemoglobin 142 g/l 115–155 g/l
White cell count (WCC) 4.5 × 109/l 4–11 × 109/l
Platelets 170 × 109/l 150–400 × 109/l
Sodium (Na+) 138 mmol/l 135–145 mmol/l
Potassium (K+) 3.6 mmol/l 3.5–5.0 mmol/l
Urea 9.8 mmol/l 2.5–6.5 mmol/l
Creatinine 125 μmol/l 50–120 µmol/l
Which of the following is the most likely cause of her vomiting?

MSFinals-5256

A 74-year-old patient has been admitted for cholecystectomy. While you are writing up her drug chart, the patient informs the SHO that she is on digoxin for a heart condition.
With regard to digoxin, which of the following statements is correct?

MSFinals-5258

In pharmacokinetics, how is the rate of elimination or metabolism of an active drug from the body calculated?

MSFinals-5259

A 60-year-old male comes back to your clinic for a follow-up on his poorly controlled diabetes, despite being on multiple medications. After a discussion with him, you decide to start him on pioglitazone. What is a common side effect of this medication that he should be advised about?

MSFinals-5260

You are assessing a 49-year-old woman during a general practice visit who has recently been diagnosed with pulmonary fibrosis. As you review her medication history, you wonder which of the following medications could potentially be a contributing factor to her condition.

MSFinals-5261

For warfarin, the volume of distribution is 8 litres, while for chloroquine, it is 15,000 litres. Which statement is correct?

MSFinals-5262

A 75-year-old man with chronic heart failure is prescribed digoxin for atrial fibrillation. The patient expresses anxiety about starting a new medication. What is the recommended frequency for monitoring the levels of this medication?