Archives: Medical Student Finals

MSFinals-4881

A 60-year-old man presents to the Accident & Emergency Department following an overdose of one of his medications. On initial triage, his blood pressure is found to be 72/48 mmHg, heart rate 34 bpm and his serum blood glucose is recorded as 1.4 mmol/l. A 12-lead electrocardiogram (ECG) shows sinus bradycardia. He has a past medical history of hypertension, atrial fibrillation, insulin-dependent type 2 diabetes and hypercholesterolaemia.
Which of the following medications is most likely to be responsible for this patient’s symptoms?

MSFinals-4882

A 75-year-old man with atrial fibrillation presented 9 months after discharge from hospital, following a myocardial infarction. He had no further chest pain but had developed swelling of the breasts, which was uncomfortable on occasion. Upon examination, tender bilateral gynaecomastia was observed.
Which medication he is currently taking is most likely responsible for this condition?

MSFinals-4883

A 56-year-old man comes to the clinic for follow-up. He has chronic cardiomyopathy with heart failure and is on a medication regimen of furosemide, spironolactone, ramipril, carvedilol, and digoxin. He is currently stable with a blood pressure reading of 120/75 mmHg, no signs of cardiac failure, and an exercise tolerance of 250 m. However, he reports experiencing breast tenderness. Which medication is the most likely culprit?

MSFinals-4884

A 67-year-old male presents to the emergency department with symptoms of nausea, diarrhoea, confusion, and blurred vision. He has a medical history of osteoarthritis, heart failure, and atrial fibrillation. His current medications include Adcal D3, Amiodarone, Bisoprolol, Digoxin, Losartan, and Paracetamol. The patient was recently started on amiodarone by his general practitioner. What is the probable cause of his current symptoms?

MSFinals-4885

A 67-year-old male patient arrives at the Emergency Department with a rash. He has been experiencing fever and fatigue for three days, but within the last 12 hours, a rash has developed. He is extremely anxious and in severe pain. The rash is primarily on his face and torso, consisting of a combination of target lesions and blisters. His tongue and lips show significant mucosal desquamation. You identify this as a severe and uncommon side effect of one of his medications.
What medication is the most probable cause?

MSFinals-4886

A pediatric patient who attends the cardiology clinic is prescribed a new medication as an anti-arrhythmic. The cardiologist informs you that this medication works predominantly by blocking the potassium channels.
Which of the following medications is this most likely to be?

MSFinals-4887

A 22-year-old woman is admitted to the Acute Admissions Ward, having taken an overdose. She is drowsy and poorly responsive. On examination, her blood pressure is 75/40 mmHg, and her pulse is 42 bpm and regular; there are bibasal crackles on auscultation of her chest. While in the unit, she suffers from a tonic–clonic seizure.
Investigations:
Investigation Result Normal value
Haemoglobin 141 g/l 115–155 g/l
White cell count (WCC) 4.2 × 109/l 4–11 × 109/l
Platelets 200 × 109/l 150–400 × 109/l
Sodium (Na+) 140 mmol/l 135–145 mmol/l
Potassium (K+) 5.0 mmol/l 3.5–5.0 mmol/l
Creatinine 74 μmol/l 50–120 µmol/l
Glucose 2.8 mmol/l 3.5–5.5 mmol/l
Electrocardiography Severe bradycardia,
no signs of acute ischaemia
Which of the following medications has she most likely taken an overdose of?

MSFinals-4888

You assess a 74-year-old male patient who comes to the clinic with deteriorating heart failure. During the examination, you observe that his blood pressure is high at 152/90 mmHg. Additionally, his general practitioner has recently prescribed him regular diclofenac for joint pain. Can you identify one of the suggested ways in which NSAIDs cause the retention of salt and water?

MSFinals-4889

A 50-year-old-man complains of abdominal pain and exhibits guarding during examination. A CT scan of the abdomen with contrast is recommended. The patient has a medical history of diabetes and high cholesterol and is currently taking metformin 500 mg BD and atorvastatin 20 mg OD. What advice would you give him regarding the CT scan?

MSFinals-4890

A medication is administered via intramuscular injection. What is the term used to describe the process by which it enters the individual’s circulatory system?