Archives: Medical Student Finals

MSFinals-4934

A 27-year-old man is brought to the emergency department by his roommate after he saw him convulsing on the floor of the bathroom. On arrival, he is found unresponsive to sternal rub. His vitals are:

Temperature: 37.5°C
Pulse: 120/min
Blood pressure: 100/60 mmHg
Respiratory rate: 14/min
Oxygen saturation: 96% on room air

Physical examination reveals hot and dry skin. The patient’s pupils are dilated and minimally responsive to light. ECG shows a QRS duration of 130ms. His past medical history is significant for depression, alcohol dependence, marijuana use, and occasional IV drug use.

What is the most appropriate treatment option for this patient?

MSFinals-4935

A 28-year-old female patient visits her GP with a recent rash. She has developed painful, hot, and bright red lumps on her shins. Additionally, she is experiencing fever and generalised arthralgia. You suspect that the medication she is taking may be the cause of her rash.
Which medication is the most likely culprit?

MSFinals-4936

A 25-year-old man with a history of severe mental illness presents to the Emergency Department with emesis, abdominal pain and stupor. The paramedic reports that the patient was found unconscious with a container of windshield washer fluid in his hands.
During examination, the patient’s breath has a strong smell of alcohol. As part of the initial assessment, an arterial blood gas (ABG) is performed.
Investigation Result Normal value
pH 7.25 7.35–7.45
pCO2 4.6 kPa 4.6–6.0 kPa
pO2 13.2 kPa 10.5–13.5 kPa
HCO3- 14 mmol/l 24–30 mmol/l
Potassium (K+) 3.8 mmol/l 3.5–5.0 mmol/l
Sodium (Na+) 142 mmol/l 135–145 mmol/l
Chloride (Cl-) 102 mmol/l 98–106 mmol/l
What is the most appropriate therapeutic option for this patient?

MSFinals-4937

A 14-year-old girl is brought to the Emergency Department by her mother, who found her on the bathroom floor. She is ataxic, appears confused and her speech is slurred, however she does not smell of alcohol. She says she ‘took something’ because she wanted to end her life. She has vomited twice.

On the blood gas, there is a metabolic acidosis.

What is the most appropriate treatment for this situation?

MSFinals-4938

Drugs X and Y can both act upon a receptor Z to inhibit a biological effect by decreasing the activity of an intracellular signalling pathway.
At its maximal concentration, drug X can completely inhibit the intracellular signalling pathway. However, drug Y can only inhibit around half the effect, even at maximal concentration.
What term would you use to describe the action of drug Y?

MSFinals-4939

Drugs X and Y can both bind to receptor Z and activate an intracellular signalling pathway. At their highest concentrations, drug X can fully activate the pathway, while drug Y can only activate it to a moderate extent. This difference in efficacy can be attributed to the varying affinities of the drugs for the receptor or their ability to induce conformational changes in the receptor.
What term would you use to describe the action of drug X?

MSFinals-4940

A 38-year-old woman arrives at the emergency department complaining of palpitations that began a few hours ago. Her heart rate is 180/min and an ECG reveals atrial fibrillation. The attending cardiologist plans to use flecainide to pharmacologically convert the patient back to sinus rhythm. What pre-treatment measure should be taken before administering flecainide?

MSFinals-4941

In the field of pharmacology, what is the term used to describe a ligand that binds to a receptor and induces a biological response by altering the receptor state, usually resulting in an increase in receptor activity?

MSFinals-4942

You are asked to assess a 50-year-old woman who has a medical history of bipolar disorder and is currently undergoing lithium therapy. The patient seems disoriented and restless. The nurse informs you that she has ingested a significant amount of lithium, and her blood tests reveal a rapid deterioration in kidney function. As part of your initial treatment, you order fluids.
What is the most suitable course of action for further management?

MSFinals-4909

What is the mechanism of action of raloxifene in the management of osteoporosis?