Archives: Medical Student Finals

MSFinals-4865

A 55-year-old man presents to the emergency department with complaints of severe diarrhoea and vomiting for the past week. During his initial assessment, an ECG is performed, which reveals a polymorphic ventricular tachycardia. His blood pressure is 120/70 mmHg, heart rate is 82 bpm, and GCS is 15/15. Routine blood tests are conducted, and the results are as follows:
– Sodium: 136 mmol/L (135 – 145)
– Potassium: 4 mmol/L (3.5 – 5.0)
– Bicarbonate: 24 mmol/L (22 – 29)
– Magnesium: 0.4 mmol/L (0.7-1.0)
– Urea: 6 mmol/L (2.0 – 7.0)
– Creatinine: 120 µmol/L (55 – 120)

What would be the initial management plan for this patient?

MSFinals-4866

An 84-year-old woman is admitted to the hospital with a fever and difficulty breathing. She has a medical history of osteoarthritis, hypertension, and chronic kidney disease, and takes atorvastatin, amlodipine, and codeine regularly. During the examination, she appears unwell, and there are splinter haemorrhages on her nails. A systolic murmur in the mitral area is audible. Her vital signs are a pulse of 100/min, a respiratory rate of 18/min, a blood pressure of 110/90 mmHg, and a temperature of 38°C. The diagnosis of bacterial endocarditis is made based on clinical findings, and blood cultures reveal Streptococcus viridans. Appropriate IV fluids and gentamicin are administered, and she recovers from the infection. However, a few days later, she develops acute tubular necrosis.

What is the most likely cause of her acute tubular necrosis?

MSFinals-4867

What is the term used to describe the process of a drug entering the bloodstream?

MSFinals-4868

A 19-year-old female with a history of schizophrenia has been admitted multiple times in the past five years. Despite showing positive responses to medication when taken regularly, she has been noncompliant with her treatment. What is the appropriate next step in managing her condition?

MSFinals-4869

You are a healthcare professional working in a general practice. Your next patient is a 70-year-old man who has come for a follow-up appointment to review his recent blood test results. During his last visit, you had expressed concern about his elevated plasma glucose levels and advised him to make some lifestyle changes. He reports that he has made some dietary modifications and has started walking to the local shops instead of driving.

The patient has a medical history of coeliac disease, chronic kidney disease, and osteoarthritis. His fasting blood test results are as follows:

– Hemoglobin (Hb): 146 g/L (normal range for males: 135-180; females: 115-160)
– Platelets: 235 * 109/L (normal range: 150-400)
– White blood cells (WBC): 7.0 * 109/L (normal range: 4.0-11.0)
– Sodium (Na+): 139 mmol/L (normal range: 135-145)
– Potassium (K+): 4.4 mmol/L (normal range: 3.5-5.0)
– Urea: 10.4 mmol/L (normal range: 2.0-7.0)
– Creatinine: 216 µmol/L (normal range: 55-120)
– Estimated glomerular filtration rate (eGFR): 28 ml/minute
– C-reactive protein (CRP): <5 mg/L (normal range: <5)
– Plasma glucose: 7.3 mol/L (normal range: <6 mmol/L)
– Hemoglobin A1c (HbA1c): 54 mmol/mol

What would be the most appropriate course of action for managing this patient’s HbA1c levels?

MSFinals-4870

A 56-year-old man presents to the hospital with a four-day history of diarrhea. He has a medical history of type II diabetes mellitus, hypertension, and chronic renal impairment. His regular medications include metformin, gliclazide, ramipril, and amlodipine. Upon examination, he appears confused, hypotensive with a blood pressure of 84/44 mmHg, and tachycardic with a heart rate of 110 bpm. A venous blood gas test was performed, revealing a pH of 6.9 (normal range: 7.35 – 7.45), bicarbonate of 8 mmol/L (normal range: 22 – 28), base excess of -16 (normal range: -2 – 2), lactate of 11.2 mmol/L (normal range: < 1.0), sodium of 148 mmol/L (normal range: 135 - 145), potassium of 5.0 mmol/L (normal range: 3.5 - 5.0), chloride of 97 mmol/L (normal range: 95-105), and glucose of 12.4 mmol/L (normal range: 3.9 - 5.8). What is the most likely cause of his metabolic derangement?

MSFinals-4871

A 45-year-old man with a history of alcohol abuse is admitted to the hospital with alcohol intoxication. During his admission, it was noted that he has mild hypomagnesemia. The hospital’s protocol suggests oral magnesium replacement for patients with mild hypomagnesemia. What is the typical adverse effect of using this type of replacement therapy?

MSFinals-4872

A 72-year-old retired teacher is receiving Palliative Care for advanced carcinoma of the liver. The patient has been prescribed ondansetron to alleviate symptoms of nausea and vomiting and wants to know about the potential side-effects of the medication.
What is a typical side-effect of ondansetron?

MSFinals-4873

A young adult with Graves’ disease is started on carbimazole. What crucial adverse effect should be emphasized to the patient?

MSFinals-4874

Which one of the following statements regarding the reporting of medication related adverse events using the Yellow Card scheme is accurate?