Archives: Medical Student Finals

MSFinals-4989

A 16-year-old male has presented to the emergency department after taking an overdose of paracetamol. His paracetamol levels were recorded on admission and the decision to treat with IV acetylcysteine was made. Upon admission, his physical observations were all within normal ranges.

While attending to another patient, you are urgently called to reassess this young male. He is now complaining of severe shortness of breath and describes himself as feeling ‘funny’. The IV acetylcysteine was started 10 minutes ago. The nurse has kindly carried out a set of observations for you below.

Respiratory rate – 32 breaths per minute
Oxygen saturations – 87%
Blood pressure – 114/71 mmHg
Heart rate – 106bpm
Temperature – 37.1ºC

What is the most appropriate response to this situation?

MSFinals-4990

A 78-year-old man with atrial fibrillation was admitted to hospital with a fractured neck of femur. He was maintained on digoxin 187.5 μg daily. On examination, his pulse was 70 bpm and his blood pressure was 124/76 mmHg. He was fully conscious.
Investigation: plasma digoxin (taken at least 6 hours post-dose) 2.5 nmol/l (1.0–2.0)
What is the most appropriate action regarding his digoxin dosage?

MSFinals-4991

A 57-year-old man who smokes 20 cigarettes daily developed heart failure post-myocardial infarction. He is prescribed ramipril but decided to stop it due to a persistent dry cough.
What is the mechanism of an angiotensin-converting enzyme (ACE) inhibitor-related cough?

MSFinals-4992

A 67-year-old woman develops a urinary tract infection (UTI) and is prescribed amoxicillin. She has a medical history of well-controlled type II diabetes mellitus with metformin and atrial fibrillation managed with warfarin. She has been consuming multiple glasses of cranberry juice daily, as she was informed it could prevent UTIs. During a routine check-up, her INR is found to be 6. How does cranberry juice impact the INR?

MSFinals-4993

A 35-year-old female patient comes to the clinic for follow-up. She has been diagnosed with severe endometriosis and has not responded well to previous treatments. You decide to initiate therapy with an intranasal GnRH analogue. What is the correct representation of the long-term mechanism of action of GnRH analogues in the management of endometriosis?

MSFinals-4994

A 60-year-old woman with localised breast cancer is considering starting tamoxifen therapy. She has a history of well-controlled hypertension (on amlodipine) and underwent a total hysterectomy with bilateral salpingo-oophorectomy 3 years ago. What is the most crucial aspect for the woman to be informed about regarding the proposed treatment?

MSFinals-4995

A 32-year-old female with a history of depression is being evaluated. She is presently using St John’s Wort, which she purchased from a nearby health food store, and a combination oral contraceptive pill. What is the probable outcome of taking both drugs simultaneously?

MSFinals-4973

A 42-year-old man presents with a one-month history of tingling sensation in his fingers, toes and around the mouth. Initially, the symptom only affected his fingers but has since spread and gradually worsened. He had a similar symptom a couple of years ago and was diagnosed with low calcium levels. The patient reports no muscle weakness, tremors or other neurological symptoms. He is currently taking esomeprazole for reflux symptoms. His recent blood test showed a calcium level of 2.2 mmol/L (2.1-2.6). What electrolyte abnormality could be causing this patient’s presenting symptoms?

MSFinals-4974

A 55-year-old woman visits her General Practitioner (GP) with complaints of feeling down for some time. She reports experiencing episodes lasting approximately three minutes where she suddenly becomes very anxious and hyperventilates. Upon further inquiry, the GP discovers that this has been progressively worsening over the past two months. The patient is interested in knowing if there are any medications that could assist her.
What is the mode of action of monoamine oxidase inhibitors?

MSFinals-4975

A 75-year-old patient is admitted to the hospital for an elective total hip replacement. Thromboprophylaxis with dalteparin is administered before the surgery. After eight days, the patient complains of pleuritic chest pain and shortness of breath. The full blood count results reveal a pulmonary embolism. The following are the patient’s blood count results: Hb 124 g/L (Female: 115-160; Male: 135-180), Platelets 76 * 109/L (150-400), and WBC 6 * 109/L (4.0-11.0). What is the most probable cause of the pulmonary embolism?