Archives: Medical Student Finals

MSFinals-4875

A 65-year-old farmer presents to the emergency department with abdominal pain and difficulty breathing. He has vomited twice and experienced incontinence with both diarrhoea and urine. The patient reports taking atorvastatin, metformin, ramipril, and sertraline, and also ingesting a pesticide. Upon examination, he exhibits excessive respiratory secretions and hypersalivation, miosis, wheezing, a blood pressure of 94/52 mmHg, a heart rate of 52 beats per minute, a respiratory rate of 12 breaths per minute, and an oxygen saturation of 84%. What is the initial antidote that should be administered?

MSFinals-4876

A 32-year-old man presents to the emergency department with acute confusion and disorientation over the past 2 days. His vital signs are notable for a heart rate of 122 /min, oxygen saturation of 98% on air, BP 168/88 mmHg, and temperature of 37.9ºC. Physical examination reveals sweating, upper limb rigidity, and hyperreflexia. An ECG shows sinus tachycardia. The patient has a history of depression, anxiety, schizophrenia, and lower back pain, and is currently taking sertraline. He recently started a new medication after seeing his GP. Which medication is most likely responsible for his symptoms?

MSFinals-4877

A 45-year-old man has been admitted to hospital for pain management. The patient has metastatic lung cancer and is undergoing palliative radiotherapy. He received his last dose of analgesia 3 hours ago. On inspection, the patient is obtunded and has constricted pupils and a respiratory rate of 6 breaths per minute.
Which analgesia is the patient most likely to have received to cause this adverse reaction?

MSFinals-4878

A 36-year-old man arrives at the emergency department after taking an unknown substance during a night out. He has a history of depression. Upon examination, his GCS is 13/15, his pupils are dilated and divergent, and he is tachycardic with a heart rate of 110/min. His blood pressure is 124/70 mmHg, and his ECG shows sinus rhythm with a prolonged QTc duration of 480 msec. He appears dehydrated. What substance is most likely responsible for his symptoms?

MSFinals-4843

A 43-year-old man arrives at the emergency department after experiencing a convulsive episode while heavily drinking at a friend’s party. Despite having no history of seizures, he has a medical background of depression and is currently taking sertraline. Urine toxicology reveals a significant amount of cocaine and small traces of cannabis. What is the probable reason for his seizure?

MSFinals-4844

As part of a palliative care attachment for final-year medical students, the consultant is discussing non-pharmacological options for managing pain symptoms. The focus is on herbal therapies that have been clinically proven to provide analgesic benefits in palliative care.

MSFinals-4845

A 60-year-old woman has undergone routine blood tests during her annual check-up with her primary care physician. She has been feeling quite tired lately and has noticed some tremors in her hands, but has attributed these changes to getting older. Her medical history includes chronic indigestion, osteoarthritis in her knees, and high blood pressure. She takes omeprazole, cimetidine, ibuprofen, paracetamol, codeine phosphate, and amlodipine on a regular basis. The following are the results of her blood tests:

Hb 150 g/L Male: (135-180) Female: (115 – 160)
Platelets 180 * 109/L (150 – 400)
WBC 7.0 * 109/L (4.0 – 11.0)
Na+ 140 mmol/L (135 – 145)
K+ 3.4 mmol/L (3.5 – 5.0)
Urea 6.6 mmol/L (2.0 – 7.0)
Creatinine 110 µmol/L (55 – 120)
CRP 1 mg/L (< 5)
Bilirubin 15 µmol/L (3 – 17)
ALP 60 u/L (30 – 100)
ALT 21 u/L (3 – 40)
γGT 25 u/L (8 – 60)
Albumin 44 g/L (35 – 50)
Calcium 2.0 mmol/L (2.1-2.6)
Phosphate 0.9 mmol/L (0.8-1.4)
Magnesium 0.5 mmol/L (0.7-1.0)
Thyroid stimulating hormone (TSH) 5.1 mU/L (0.5-5.5)
Free thyroxine (T4) 15 pmol/L (9.0 – 18)
Amylase 100 U/L (70 – 300)
Uric acid 0.30 mmol/L (0.18 – 0.48)
Creatine kinase 120 U/L (35 – 250)

Which medication is most likely responsible for these blood test results?

MSFinals-4846

A 28-year-old patient is seen in clinic with persistent aching pain at the site of a surgically treated fractured tibia and fibula following a road traffic accident. The patient is currently taking paracetamol 1 g four times a day. What would be the most suitable analgesic to prescribe next?

MSFinals-4847

A 28-year-old woman arrives at the emergency department at 2 pm after intentionally overdosing on paracetamol the previous night at 10 pm. She admits to taking the entire contents of two packs of paracetamol, each containing 16 500 mg tablets, and now regrets her decision.

The patient is conscious and her vital signs are normal. Physical examination findings are unremarkable, and there are no signs of jaundice. She has a medical history of mixed anxiety and depression. Her weight is 60kg. Blood test results are pending.

What is the most appropriate course of action for her treatment?

MSFinals-4848

A 68-year-old male comes to your clinic with an inflamed left big toe, and you diagnose it as his second gout episode this year. His recent blood tests show normal kidney function. What is the next best step to take?