Archives: Medical Student Finals

MSFinals-5202

A 25-year-old man is brought in by ambulance to the Emergency Department after a night out. His friend said he had taken some unknown substance in a club. On examination, patient looks dry. He has a GCS 13/15 and pupils are dilated and divergent. He also had a palpable bladder on abdominal examination:
Investigation Result Normal value
Heart rate (HR) 112 bpm 60–100 beats/min
Blood pressure (BP) 120/70 mmHg < 120/80 mmHg
Respiratory rate (RR) 18 breaths/min 12–18 breaths/min
Sats 96% on air 94–98%
An electrocardiogram (ECG) was done which showed sinus tachycardia with a prolonged QTc of 580 ms.
What Is the mostly likely drug he has taken to cause this presentation?

MSFinals-5203

A 51-year-old woman with bipolar affective disorder is brought to casualty by her daughter after being found at home with two empty bottles of her prescribed medication (lithium) by her side. She is believed to have taken the tablets several hours ago. No other tablets were found at the scene.
She is Glasgow Coma Scale (GCS) 14/15 and is haemodynamically stable.
Investigations:
Investigation Result Normal value
Serum lithium level 5.9 mmol/l Therapeutic range: 0.4–1.0 mol/l
Haemoglobin 123 g/l 115–155 g/l
White cell count (WCC) 9.1 × 109/l 4–11 × 109/l
Platelets 199 × 109/l 150–400 × 109/l
Sodium (Na+) 136 mmol/l 135–145 mmol/l
Potassium (K+) 5.0 mmol/l 3.5–5.0 mmol/l
Urea 28 mmol/l 2.5–6.5 mmol/l
Creatinine 550 μmol/l 50–120 μmol/l
Which one of the following is the treatment of choice?

MSFinals-5204

During the ward round you notice that a 75-year-old man, who was admitted last night with community acquired pneumonia, is not on any prophylaxis for venous thromboembolism. His background history is significant for hypertension, chronic kidney disease stage 4 and one previous deep venous thrombosis 10 years ago.

On his admission bloods his creatinine clearance is 20 mL/min. His electrocardiogram shows sinus rhythm.

What is the most appropriate course of action regarding his need for venous thromboembolism prophylaxis?

MSFinals-5206

Which one of the following ECG changes is most consistent with a tricyclic overdose in a patient of a different age?

MSFinals-5207

Mrs. Johnson is a 45-year-old civil engineer who was recently diagnosed with type 2 diabetes at her NHS over-40 health check. Your colleague started her on metformin two weeks ago, but she has asked for a telephone consultation as she is still experiencing nausea with it. She says she has tried to persevere but now she has had enough and wants to stop it. Her HbA1c at diagnosis was 52 mmol/l. Her body mass index is 31kg/m². Her renal function is normal.

What is the most appropriate medication option to try next?

MSFinals-5208

A 55-year-old man with Tourette’s and poorly controlled type 2 diabetes presents to you with concerns about intermittent chest pain on exertion. He drinks 21 units of alcohol per week and smokes 20 cigarettes a day. His father died of a myocardial infarction at the age of 56 years. You refer him for suspected angina, provide advice on worsening chest pain, and prescribe a GTN spray for use as needed. While prescribing the GTN spray, you notice a medication on his prescription list that he should avoid taking while being investigated for chest pain or using the GTN spray. What medication is this referring to?

MSFinals-5209

A 48-year-old woman has been evaluated by her GP for the reason behind her low energy, weight gain and depressed mood. After undergoing biochemical testing, she was discovered to have elevated levels of thyroid-stimulating hormone (TSH) and decreased levels of T3 and T4. The diagnosis of primary hypothyroidism was made and she was started on levothyroxine.
When is it appropriate to repeat this patient’s thyroid function tests (TFTs)?

MSFinals-5210

A 26-year-old electrician is instructed to be nil by mouth upon admission with suspected appendicitis, and is prescribed IV fluids to be given before and after the procedure to ensure proper hydration.
What is the composition of a bag of normal saline 0.9% (in mmol/l)?

MSFinals-5212

Which diuretic inhibits the co-transport of Na+/K+/2Cl- in the thick ascending limb of the loop of Henle?