Archives: Medical Student Finals

MSFinals-4959

A 36-year-old woman with a history of Von Willebrand disease underwent a left knee arthroscopy and screw removal with epidural anesthesia. The epidural space was identified at L3-L4 and local anesthetic was administered. During the operation, the patient experienced sensory block to temperature up to the T10 dermatome. After the procedure, the patient was comfortable and the block resolved completely after 2 hours. However, 2 hours later, the patient complained of severe back pain and exhibited 3/5 power in all muscle groups of the right leg, absent right patellar reflex, and reduced sensation to light touch in the right leg.

What complication of epidural anesthesia is likely to be demonstrated in this case?

MSFinals-4960

A 57-year-old man presents to the emergency department with seizures. He has a history of bipolar disorder and migraines. His medications include lithium, amitriptyline and paracetamol. His partner reports he has recently been using ibuprofen regularly over the counter.

On examination, he is postictal and appears dehydrated. Blood results reveal elevated levels of sodium, potassium, urea, creatinine, and lithium. Resuscitation is initiated with intravenous 0.9% normal saline.

What is the definitive management for this patient’s presentation?

MSFinals-4926

A woman has been started on amiodarone for cardiac arrhythmias.
Which one of the following options are the mandatory blood tests to be conducted on patients taking amiodarone?

MSFinals-4927

A 76-year-old man is admitted to hospital with worsening control of his chronic back pain. He admits he is struggling to continue with his oral morphine as it is making him feel nauseated. He enquires about whether he can have injections or an analgesia patch. He currently takes paracetamol 1000 mg orally (PO) four times daily (QDS), codeine 60 mg PO QDS, ibuprofen 400 mg PO three times daily (TDS) and morphine sulphate 30 mg PO QDS.
Which of the following fentanyl patches would be appropriate for this patient?

MSFinals-4928

A 10-year-old girl is brought to the Emergency department by her father. She states that she accidentally swallowed 20 tablets of ferrous sulphate from the family medicine cabinet. What is the recommended treatment for acute iron toxicity?

MSFinals-4929

A 68-year-old woman with known carcinoma of the breast is admitted to the Emergency Department with sudden onset of breathlessness. The patient also describes pleuritic-type chest pain which started just under one hour previously at the same time as the onset of the breathlessness, and she is now breathless at rest.
On examination, the patient is cyanosed, has a tachycardia of 122 bpm and a blood pressure of 86/60 mmHg. An electrocardiogram (ECG) shows signs of right ventricular dysfunction.
A diagnosis of pulmonary embolism is made, and the decision is taken to administer a thrombolytic.
Which of the following agents is a thrombolytic?

MSFinals-4930

A 28-year-old patient is attending her routine check-up at the general practice. She was prescribed lithium for bipolar disorder two years ago and reports a new symptom. The doctor suspects lithium toxicity. What might the patient be experiencing?

MSFinals-4931

A 45-year-old man with multiple sclerosis has been taking methadone for relief of painful muscle spasms. He has been struggling to accept his condition, and chronic pain has caused him to feel depressed. His doctor has prescribed him amitriptyline at night to help with depression and sleep. During a routine check-up, an ECG is performed.
What ECG abnormality could potentially be caused by a drug interaction in this patient?

MSFinals-4932

A 67-year-old patient presents to the Emergency Department with a 4-day history of worsening confusion, vomiting, and lethargy. Upon examination, the lungs are clear and the heart sounds are fast and irregularly irregular. The patient has a medical history of uncontrolled hypertension and atrial fibrillation and is currently taking ramipril, amlodipine, and digoxin. It is suspected that a new medication has been recently added. What is the most likely medication that has been started?

MSFinals-4933

A 25-year-old man is brought to the Emergency Department by his friends. They suspect he has taken an illicit substance but are unsure of what he has consumed. The patient reports feeling disconnected from his body and experiencing vivid visual hallucinations of colorful, abstract shapes. He expresses concern about being watched and unable to return to normal. Additionally, he complains of a dry mouth, headache, and nausea. Upon examination, the patient appears agitated, with dilated pupils, tachycardia, and mild hypertension. Hyperreflexia is also noted in the limbs. What would be an appropriate management step for this patient, considering the probable substance ingested?