Archives: Medical Student Finals

MSFinals-6687

A 22-year-old student is hit by a bus while cycling to university at moderate speed. He falls and lands on the curb, hitting his left ribs. There is no loss of consciousness. He is brought into the Emergency Department, complaining of left upper quadrant (LUQ) pain. On examination, his heart rate is 120 bpm after morphine analgesia; his blood pressure is 100/65 mmHg and he is peripherally cold; the respiratory rate is 25 and saturations are 99% on room air. Chest X-ray reveals displaced left lower rib fractures, without other thoracic pathology.
What diagnosis would you be most concerned about?

MSFinals-6688

A 21-year-old man is brought to the Emergency Department after a car accident. He is breathing irregularly, with a respiratory rate of five breaths/minute, and has a Glasgow Coma Scale (GCS) score of three. The trauma team decides to intubate him in the department, but due to oropharyngeal swelling caused by the trauma, they are unable to do so. His condition rapidly deteriorates, and he is now hypoxic, with an oxygen saturation (SpO2) of 70%, despite receiving mechanical ventilation with a bag-valve-mask and basic airway manoeuvres. What is the most appropriate intervention to restore his oxygenation?

MSFinals-6689

A 21-year-old woman who is 28 weeks pregnant with her first child comes to the Emergency Department after being electrocuted by a faulty power socket in her apartment. Her echocardiogram reveals no abnormalities and her conduction system is normal after eight hours of cardiac monitoring.
What would be the most suitable course of action for managing this patient?

MSFinals-6690

An 8-year-old boy arrives at the Emergency Department after falling on his outstretched hand. He is experiencing severe pain and cannot move his arm. An X-ray shows a fracture of the distal radius, along with dislocation of the distal radioulnar joint. The ulna appears to be intact. What is the most probable type of injury that this patient has suffered?

MSFinals-6691

A 22-year-old man was brought to the Emergency Department with a knife still in his abdomen after being stabbed in the left upper quadrant. A CT scan revealed that the tip of the knife had pierced the superior border of the greater omentum at the junction of the body and pyloric antrum of the stomach. Which direct branch of a vessel is most likely to have been severed by the knife?

MSFinals-6692

A 26-year-old man has been involved in a motorbike accident. Although he is not seriously injured, he has sustained a skin flap on the dorsal surface of his wrist after hitting it against a wall. Upon examination, it is observed that the extensor pollicis longus tendon is exposed and can be seen changing direction around a bony projection. What is the name of this bony feature?

MSFinals-6693

A 26-year-old woman is brought into the Emergency Department (ED) by the Helicopter Emergency Medical Service (HEMS) in severe hypovolaemic shock. She was involved in a multiple vehicle accident and has sustained injuries all over her body, including her head, chest, abdomen, and long bones. She is intubated with C-spine control and a large bore subclavian line is inserted for resuscitation. In the ambulance, she received 2 units of packed red cells (PRC) and 2 units of fresh frozen plasma (FFP), but she still has a very weak pulse.
Her initial blood gas shows a pH of 6.9 and resuscitation efforts continue as she is given another 3 units of PRC and 3 units of FFP on the way to the operating theatre. Platelets and cryoprecipitate are also requested. Despite these interventions, her pulse remains weak and the anaesthetist is struggling to place an arterial line for blood pressure monitoring and continued blood sampling. During this time, you observe a change in her electrocardiogram (ECG): it was previously narrow and fast, but is now broad and slowing down.
What is the most likely explanation for this change in the ECG?

MSFinals-6694

A 50-year-old electrician is admitted to the Emergency Department following an electrical injury at work. He experienced a current-induced dysrhythmia and has been under observation for the past 24 hours. His current echocardiogram monitoring shows no abnormalities, and he is comfortable at rest with a respiratory rate of 12 breaths per minute. The patient is normovolemic. What electrolyte abnormality is he most susceptible to developing?

MSFinals-6695

A 29-year-old man has been assaulted with a baseball bat. He is brought to the Emergency Department as a major trauma ‘code red’ call. He has already had drug-assisted intubation at the scene and a thoracostomy to his left chest. He remained critical throughout the journey to hospital, receiving intravenous (IV) fluids and 2 units of O-negative red blood cells. On primary survey, he has equal chest expansion, but with crepitus and clear injuries to his left chest. He is tachycardic at 160 bpm, with an unrecordable blood pressure (BP). On further exposure, he has multiple marks over his abdomen and torso, and a distended, tense abdomen. A FAST scan is positive, with free fluid in the abdomen. A concurrent chest X-ray shows fractured ribs on the left, but otherwise clear lung fields, without haemothorax. He has now received 3 units of packed red cells and 2 units of fresh frozen plasma, along with 2 litres of crystalloid fluid. Following these interventions, his BP is recorded at 74 mmHg systolic, and he remains unstable.
What would be the next most appropriate management step?

MSFinals-6663

A 67-year-old man presents to the emergency department with a 3-hour history of right-sided loin to groin pain. He has never experienced pain like this before and regular analgesia has not relieved his symptoms. His past medical history includes hypertension for which he takes amlodipine and indapamide.

His observations are as follows:

Temperature 35.8ºC

Heart rate 105 bpm

Blood pressure 100/60 mmHg

Respiratory rate 22 breaths/min

Saturations 96% on air

On examination, he is clammy to touch. His chest is clear and heart sounds are normal. There is generalised abdominal tenderness and central guarding. Bowel sounds are present.

What is the most appropriate next step in the management of this patient?