Archives: Medical Student Finals

MSFinals-5091

A 75-year-old man presents with seizures. He has a past medical history of dementia and severe COPD for which he uses salbutamol, ipratropium and oral theophylline. His son reports seeing his father taking a lot of pills this morning.

Given his history of COPD and possible substance toxicity, an arterial blood gas (ABG) was performed.

pH 7.21 (7.35-7.45)
pCO2 3.3kPa (4.5-6.0)
pO2 7.8 kPa (10.0 – 14.0)
HCO3- 18 mmol/L (22-26)

What is the definitive management to treat the possible toxicity?

MSFinals-5060

A 72-year-old male patient is admitted to hospital with an acute arterial thrombosis in his left leg. He requires an intravenous infusion of an anticoagulant whilst waiting for surgery. This drug requires monitoring and dose adjustment.
How is this managed?

MSFinals-5061

A 45-year-old woman with a metallic heart valve has undergone an elective paraumbilical hernia repair. Due to her valve, she is administered unfractionated heparin during the perioperative period. Assuming her renal function is normal, what is the recommended method for monitoring the therapeutic effectiveness?

MSFinals-5062

A 50-year-old woman is experiencing facial muscle control issues and difficulty speaking after receiving an intravenous injection of an antiemetic 3 hours ago. She is currently undergoing chemotherapy and is suffering from nausea. During your examination, you notice that her eyes are deviated upwards and outwards, and she is unable to make direct eye contact with you while making unusual facial expressions.
Which of the following antiemetic medications is most likely responsible for these symptoms?

MSFinals-5065

A 25-year-old female arrives at the emergency department after overdosing on a substance. She reports experiencing tinnitus and displays signs of anxiety and sweating. Your task is to conduct an arterial blood gas (ABG) test. What are the probable ABG findings?

MSFinals-5066

A 16-year-old female patient arrives at the Emergency Department after overdosing on medication found in her home. She currently has a Glasgow Coma Scale (GCS) score of 15/15 but is hesitant to disclose what she ingested. According to her mother, it may have been acetazolamide, a carbonic anhydrase inhibitor. As part of her evaluation, a venous blood gas is obtained.
If the patient’s mother is correct, what biochemical abnormality would you anticipate?

MSFinals-5067

You receive a discharge summary for Ms Chen, a 65-year-old lady, who has had an acute surgical admission with pancreatitis. The summary notes that it was thought to be drug-related. Her past medical history includes atrial fibrillation and type 2 diabetes. Her regular medications are ramipril, warfarin, gliclazide, sitagliptin, and simvastatin. She also takes an over-the-counter vitamin C supplement.
Which of her medications might have caused this presentation and should be reported by Yellow Card?

MSFinals-5070

A 65-year-old man from a nursing home was brought in by ambulance to the Emergency Department feeling generally unwell. He was recently treated with amoxicillin for community acquired pneumonia by his GP. The nursing staff said yesterday he was complaining of some muscle pain and weakness and tiredness. He has been vomiting over the last few days. He has a past medical history of asthma, type II diabetes, gout, hypercholesterolaemia and osteoarthritis. Medication includes simvastatin, co-codamol, allopurinol, metformin and a salbutamol inhaler. On examination:
Investigation Result Normal
Respiratory rate (RR) 23 breaths/min 12–18 breaths/min
Sats 96% on air 94–98%
Blood pressure (BP) 126/68 mmHg <120/80 mmHg
Heart rate (HR) 98 beats/min 60–100 beats/min
Temperature 36.8ºC 36.1–37.2°C
He is drowsy but nothing remarkable otherwise. An arterial blood gas (ABG) on air showed:
Investigation Result Normal
pH 7.28 7.35–7.45
pO2 12.0 kPa 10.5–13.5 kPa
pCO2 5.5 kPa 4.7–6.0 kPa
Bicarbonate 18 mmol/l 22–26 mmol/l
BE 1.0 –2 +2
What is the most likely cause of the above presentation and investigation results?

MSFinals-5071

You review a patient on the ward on day two of admission. He is a 16-year-old without medical history; however, his family history reveals that his mother has type II diabetes. The 16-year-old originally presented with a Glasgow Coma Scale (GCS) score of 3/15. The paramedics recorded that the glucose monitor at the scene read ‘LO’ and he was given intravenous dextrose and intramuscular glucagon. On arrival to the Emergency Department, blood glucose was 2.1 and his treatment was continued. He is now euglycaemic off treatment. Blood tests were taken at the time and they have just returned. These tests reveal that:
Serum insulin – raised
C-peptide – raised
What is the most likely cause of this patient’s presentation?

MSFinals-5072

A 26-year-old man presents to the emergency department with a suspected opioid overdose. After prompt treatment, he quickly regains consciousness. This patient has been frequenting the emergency department for the same issue over the past few months. Inpatient treatment for addiction is offered and the patient is admitted to a ward. What is the most suitable medication for this individual?