Archives: Medical Student Finals

MSFinals-5106

A 65-year-old male patient visits an outpatient cardiology clinic for follow-up. He has a medical history of heart failure, type-2 diabetes, and osteoporosis. For the past 3 years, he has been taking NovoRapid (rapid-acting insulin analogue) 10iU three times daily, Lantus (insulin glargine) 3 iU once daily, ramipril 10 mg once daily, bisoprolol 5mg once daily, and AdCal D3 (calcium and vitamin D) two tablets once daily without any adverse effects. Recently, he was prescribed amiloride 10 mg once daily. His blood work reveals:
Na+ 141 mmol/L (135 – 145)
K+ 6.0 mmol/L (3.5 – 5.0)
Bicarbonate 28 mmol/L (22 – 29)
Urea 6.3 mmol/L (2.0 – 7.0)
Creatinine 92 µmol/L (55 – 120)
Which of his medications could have interacted with the new prescription to cause the abnormal blood results?

MSFinals-5107

A 32-year-old man with a history of depression presents to the Emergency Department after taking an overdose of diazepam and dosulepin. Upon examination, his blood pressure is 118/80 and his pulse is 142 bpm. He has a respiratory rate of 9 per minute and oxygen saturations of 96% on room air. What should be the next step in managing this patient?

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?

MSFinals-5110

A 25-year-old female presents to the hospital with complaints of abdominal pain. During her evaluation, a pregnancy test is performed and unexpectedly comes back positive despite the patient claiming to have been taking her combined oral contraceptive pill as directed. Upon further investigation, it is discovered that she has recently started a medication that may have played a role in her pregnancy. What is the most likely medication that she has recently begun taking?

MSFinals-5111

A 61-year-old male visits his primary care physician complaining of central chest tightness that occurs during physical activity and subsides with rest. He has a medical history of depression, gout, gastroesophageal reflux disease, and osteoarthritis. His current medications include codeine, diclofenac, omeprazole, paracetamol, and sertraline. Based on the probable reason for his visit, which of his routine medications should be discontinued?

MSFinals-5112

A 44-year-old patient arrives at the emergency department with complaints of fever and muscle rigidity that started a few hours ago. Upon examination, the patient appears sweaty, has a temperature of 38.8ºC, and a heart rate of 103 bpm. The patient’s medical history includes depression and type 2 diabetes, for which they take sertraline and metformin. The patient visited their GP earlier in the day and was diagnosed with a new medical condition and prescribed a new medication. What could have triggered this presentation?

MSFinals-5113

Mrs. Bowls is a 65-year-old patient who presents with her ankles ‘going into spasm’ when using the pedals of her car over the past couple of days. She also reports a slight tingling in her hands and feet. Apart from this, she has been well recently, without other new symptoms. Her past medical history includes type 2 diabetes and dyspepsia. Her regular medications include metformin, sitagliptin, omeprazole, atorvastatin, and she uses sodium alginate with potassium bicarbonate after meals and before bed as required. You arrange some urgent blood tests, suspecting an electrolyte disturbance. These come back showing hypomagnesaemia.

Which of her medications should you stop?

MSFinals-5114

A 21-year-old male is brought into resus by an ambulance after being found extremely drowsy by his roommate, who wasn’t able to bring him round. The patient is borderline unconscious, with widespread clonus, extreme diaphoresis and dilated pupils. His temperature was taken and it read at 41.6ºC. When asked, the roommate states he is not completely aware of the patient’s past medical history but knows he has suffered from depression. He has also been asked to buy strange medicine from the shops for him but he cannot remember the name.
What is the most likely diagnosis in this patient?

MSFinals-5115

A 50-year-old man has been experiencing a chronic productive cough for a few months along with some instances of mild haemoptysis. He has also been losing weight unexpectedly and having night sweats. Despite having no history of smoking, a sputum sample reveals the presence of acid-fast bacilli. As part of his initial treatment, he is prescribed pyridoxine to reduce the risk of what adverse drug effect?