Archives: Medical Student Finals

MSFinals-5126

A 67-year-old man has been experiencing significant chronic back pain for several years. To manage the pain, he takes paracetamol 1000 mg orally (PO) four times daily (QDS), ibuprofen 400 mg PO three times daily (TDS) and fentanyl 25 µg/hour patch every 72 hours. He has been visiting his general practitioner (GP) as he is suffering from episodes of acute pain a few times a day and is requesting medication to take when this happens. He is allergic to morphine and has a medical history significant for chronic kidney disease, hypertension, osteoarthritis and gallstones.
What is an acceptable treatment plan for his breakthrough pain?

MSFinals-5127

A 68-year-old woman with chronic congestive cardiac failure and renal impairment complains of a red, hot, swollen toe of sudden onset. This has occurred on a number of occasions. Her current medications include aspirin and azathioprine. The diagnosis is felt to be gout and she is prescribed colchicine.
What is the most likely side-effect for the patient?

MSFinals-5128

A 75-year-old man is admitted to the hospital with severe abdominal pain and increased confusion. His family reports that he has been having difficulty walking. Upon examination, a full abdomen with a palpable bladder is noted. A prostate examination reveals a smooth, slightly enlarged prostate with an empty rectum. A bladder scan shows 1 L of urine in his bladder. The patient’s medication list includes aspirin, fexofenadine, ramipril, paracetamol, prazosin, and insulin. Which medication is most likely responsible for this presentation?

MSFinals-5129

A 67-year-old man presents to the emergency department with unilateral limb weakness and slurred speech. A CT scan of the head reveals a haemorrhagic stroke, but the medical team has no access to his records as he was found on the street. However, a warfarin card is discovered in his wallet. Upon conducting blood tests, his International Normalised Ratio is found to be 8.5. Which medication from his history is most likely to have caused this?

MSFinals-5130

A 32-year-old woman has been diagnosed with bipolar affective disorder and is taking lithium. She has a history of epilepsy. She is now experiencing symptoms of lithium toxicity and her lithium level is 1.6 mmol/L. Which medication is the most likely cause of the lithium toxicity?

MSFinals-5131

A 72-year-old patient is seen in clinic. He has a medical history of osteoarthritis, asthma, type II diabetes, dyspepsia, chronic kidney disease and atrial fibrillation. He is currently taking metformin, salbutamol, paracetamol, omeprazole and digoxin. Blood tests show a continued decline in renal function, with a GFR previously at 34 ml/min/1.73 m2 now at 26 ml/min/1.73 m2. Which medication should be discontinued at this point?

MSFinals-5132

Of the following, which one is the most useful prognostic marker in aspirin overdose?

MSFinals-5133

As an FY1 on a general medical ward, you have a patient who is experiencing nausea and vomiting and has requested an anti-sickness tablet to alleviate the symptoms. You are considering prescribing cyclizine. However, in which of the following conditions should you exercise caution when prescribing cyclizine for a patient who is elderly?

MSFinals-5108

A 35-year-old woman with bipolar disorder has been consistently taking her medication during pregnancy. During her recent ultrasound, her baby was found to have characteristics linked to spina bifida. Which medication is the most probable cause of this?

MSFinals-5109

A 39-year-old male is being released from the cardiology unit on amiodarone due to the recent diagnosis of atrial fibrillation. What side effect of this medication should you advise him on?