Archives: Medical Student Finals

MSFinals-5263

A 50-year-old G3P2 presents to the emergency department after experiencing a generalized tonic-clonic seizure. Upon arrival, her blood pressure is measured at 190/125 mmHg. The paramedics administered intramuscular magnesium sulfate to treat her seizures and she is currently receiving an IV infusion of the same medication. However, her respiratory rate is only 10 breaths per minute, indicating possible respiratory depression caused by the magnesium sulfate. What is the preferred drug for reversing this respiratory depression?

MSFinals-5264

A 28-year-old woman presents to her GP with complaints of increased fatigue. She has a medical history of epilepsy, polycystic ovarian syndrome, and depression. Additionally, she experiences occasional irritable bowel syndrome with constipation (IBS-C). Her GP orders a full blood count which reveals the following results:
– Hb 101 g/L (115 – 160)
– Platelets 350 * 109/L (150 – 400)
– WBC 8.0 * 109/L (4.0 – 11.0)
– Mean Cell Volume 100 fl (80 – 96)
– Ferritin 150 mcg/L (12 – 300)
– Folate 1.2 ng/ml (>4)
Which of her medications is most likely responsible for her current presentation?

MSFinals-5265

A 25-year-old man arrives in the resuscitation area of the Emergency Department with significant burns to his face, torso, and hands after throwing petrol on a bonfire. According to the rule of nines, he has 31.5% burns. He weighs 95 kg.
What would be the appropriate amount of fluid resuscitation based on the Parkland formula?

MSFinals-5266

A 38-year-old man weighing 100 kg was pulled from a house fire. He was intubated by the HEMS team at the scene for airway compromise (nasal soot, singed facial hair and a change in voice). He has sustained full-thickness burns to his face, anterior torso and full legs. The specialist registrar (SPR) has asked you to calculate this man’s fluids requirements for the first 24 hours.
Which of the following is the correct volume to the nearest litre?

MSFinals-5237

A 65-year-old man with known essential hypertension presents to the Emergency Department with facial swelling, difficulty breathing and stridor. He says it all started this morning and he does not remember eating anything unusual and does not have any food allergies as far as he can remember. He denies any history of asthma and does not smoke. None of his medications have been changed recently. He takes antihypertensive medications and statins.
Which medication is the most likely to have caused these side effects?

MSFinals-5245

As a doctor on the renal ward, you come across a patient with chronic kidney disease (CKD) who is experiencing pain in their right calf. The patient reports that they noticed the pain after waking up this morning. Upon examination, you notice that the calf is mildly erythematosus, painful, and hard to touch. The circumference of the right leg is 3.5 cm more than the left. The patient’s physical observations are recorded, which show a respiratory rate of 13 breaths per minute, oxygen saturations of 99% on air, blood pressure of 110/85 mmHg, heart rate of 64 beats per minute, and a temperature of 36.7ºC. The patient is alert and well orientated.

You review the patient’s most recent blood results, which indicate the following: Na+ 141 mmol/L (135 – 145), K+ 4.0 mmol/L (3.5 – 5.0), Bicarbonate 25 mmol/L (22 – 29), Urea 6.8 mmol/L (2.0 – 7.0), Creatinine 184 µmol/L (55 – 120), and eGFR 12 ml/min (>90).

Based on the patient’s symptoms and medical history, what is the most appropriate initial treatment plan?

MSFinals-5246

A 28-year-old woman is admitted with an overdose. She is currently taking antidepressants prescribed by her general practitioner and painkillers for a chronic back complaint. Other past medical history of note includes hypertension. On examination, she has a Glasgow Coma Scale (GCS) score of 7. Her pulse is 105 bpm and regular, and her blood pressure is 85/60 mmHg. Her pupils are sluggish and dilated.
Investigations:
Investigation Result Normal value
Haemoglobin 131 g/l 115–155 g/l
White cell count (WCC) 8.4 × 109/l 4–11 × 109/l
Platelets 201 × 109/l 150–400 × 109/l
Sodium (Na+) 141 mmol/l 135–145 mmol/l
Potassium (K+) 4.9 mmol/l 3.5–5.0 mmol/l
Creatinine 182 μmol/l 50–120 µmol/l
pH 7.15 7.35–7.45
pO2 8.1 kPa 10.5–13.5 kPa
pCO2 5.9 kPa 4.6–6.0 kPa
Bicarbonate 14 mmol/l 24–30 mmol/l
Which of the following is the most likely diagnosis?

MSFinals-5247

A 28-year-old woman is admitted with an overdose. She is currently taking Antidepressants prescribed by her GP and painkillers for a chronic back complaint. Other past medical history of note includes hypertension. On examination she has a GCS of 7. Her pulse is 105/min regular and her BP is 85/60 mmHg. Her pupils are sluggish and dilated.
Investigation Result Normal value
Haemoglobin 131 g/l 115–155 g/l
White cell count (WCC) 8.4 × 109/l 4–11 × 109/l
Platelets 201 × 109/l 150–400 × 109/l
Sodium (Na+) 141 mmol/l 135–145 mmol/l
Potassium (K+) 4.9 mmol/l 3.5–5.0 mmol/l
Creatinine 182 μmol/l 50–120 µmol/l
pH 7.15 7.35–7.45
pO2 8.1 kPa 10.5–13.5 kPa
pCO2 5.9 kPa 4.6–6.0 kPa
Bicarbonate 14 mmol/l 24–30 mmol/l
Which of the following is the most likely diagnosis?

MSFinals-5248

You are evaluating a new angiotensin-converting enzyme (ACE) inhibitor for lowering blood pressure in elderly patients. The half-life of the agent is 16 hours.
Which of the following reflects the likely dosing schedule for this agent in elderly patients?

MSFinals-5249

A 35-year-old woman comes for a follow-up appointment with her physician after undergoing investigations for a 6-month period of hot flashes and absence of menstruation. The patient was previously informed that the results of a series of hormone profile tests indicate that she is experiencing premature menopause. The purpose of this appointment is to discuss management options for hormone replacement therapy (HRT). After the discussion, the patient decides to choose a Mirena intrauterine system (IUS) with additional daily estrogen. What is the recommended duration for the patient to continue with HRT?