Archives: Medical Student Finals

MSFinals-5081

An 80-year-old man with a history of hypertension, gout, and complex regional pain syndrome is currently recovering from a total hip replacement surgery for a subcapital fracture neck of the femur. He is taking amlodipine 10 mg OD, allopurinol 100 mg OD, pregabalin 150 mg BD, and paracetamol 1g QDS. The patient is using a patient-controlled analgesia (PCA) pump for regular administration of IV morphine. He contacts the ward sister complaining of suprapubic pain and difficulty in passing urine.
Which medication is the most likely cause of these symptoms?

MSFinals-5082

A 38-year-old woman arrives at the emergency department with complaints of anxiety, tremors, and excessive sweating that began last night. Upon examination, the patient is visibly sweating and has a tremor with occasional jerking of the limbs. She is hypertonic in all limbs and has dilated pupils. Vital signs reveal a heart rate of 112 bpm, BP of 126/82 mmHg, sats of 97% on air, respiratory rate of 21/min, and a temperature of 38.6ºC. The patient has a history of anxiety and takes sertraline, as well as recently experiencing a shoulder injury. What is the most likely cause of her presentation?

MSFinals-5083

An 86-year-old man with a history of osteoporosis and chronic kidney disease was admitted to the hospital after falling at home and experiencing significant lower back pain. An x-ray of his lumbar spine revealed a fractured lumbar vertebra, and an MRI lumbar/sacral scan showed a new L3 burst fracture without cord compression. The neurosurgical team recommended conservative management, including pain control, physiotherapy, and mobilization as tolerated. Due to his chronic renal impairment with a creatinine clearance of 21 ml/min, the patient was started on a Buprenorphine patch. What would be the safest opioid to use for his breakthrough pain?

MSFinals-5084

A 36-year-old male intravenous drug user presented to the emergency department with fever, shortness of breath and headache. During examination, a pansystolic murmur was detected. His temperature was 39.5ºC and his heart rate was 130/min. Blood tests conducted in the emergency department showed elevated levels of WBC and CRP. He was admitted to the ward and started on empirical antibiotic treatment. However, on the second day of admission, he became anuric and a blood sample revealed abnormal levels of Na+, K+, urea, and creatinine. Which medication administered during this admission is most likely responsible for the patient’s deterioration on day 2?

MSFinals-5085

A 25-year-old male contacts emergency services claiming to have ingested insecticide in a suicide attempt. He is a final year student studying agriculture and is experiencing mental health difficulties. During the assessment, he appears lethargic and uncommunicative. His eyes are constantly watering, and he is drooling saliva. Additionally, he seems to have experienced urinary and fecal incontinence.

What physical signs would you anticipate discovering during the examination?

MSFinals-5086

What is the most frequent side effect of simvastatin therapy in the management of dyslipidemia in patients?

MSFinals-5087

A 45-year-old woman has been diagnosed with ovarian carcinoma and is scheduled to start chemotherapy. The first line chemotherapy for ovarian cancer in her area is based on paclitaxel. What is the most appropriate description of paclitaxel for this patient?

MSFinals-5088

Sarah, a 54-year-old patient, has recently received a renal transplant and has been prescribed a medication called ciclosporin to prevent transplant rejection. She is feeling anxious and wants to know about any potential side effects of this medication.
What are the possible side effects of ciclosporin?

MSFinals-5089

A 53-year-old man is brought to the ED by ambulance after his daughter found him acting strangely in the basement. During transport, he experienced a seizure lasting for 2 minutes. According to the daughter, she found an empty bottle of insecticide near him, and he had been feeling down for the past few months after his divorce.

What would be the best initial approach to managing this patient?

MSFinals-5090

A 25-year-old man collapses suddenly while standing in line at a coffee shop. He is brought into the hospital where he continues to have a reduced level of consciousness, with a Glasgow Coma Scale (GCS) of 9 (E2 V3 M4). On examination it is noted he has pinpoint pupils, low oxygen saturations, and a respiratory rate of 6 breaths/min. He has a patent airway.
What is the most appropriate treatment to initiate?