Archives: Medical Student Finals

MSFinals-4809

A 30-year-old man is brought to the emergency department by his brother at 2 pm. He was found at home with 6 opened packets of paracetamol, an empty bottle of vodka, and an empty bottle of beer. His brother last saw him at 10 pm the night before. The patient admits to drinking the alcohol throughout the night and taking 3 packets of paracetamol at 2 am and the other 3 at 6 am. The estimated paracetamol ingestion is 18g. He denies using any other substances. Blood tests are ordered and he is immediately started on IV N-acetylcysteine. What is the most important prognostic factor for this patient?

MSFinals-4810

A 56-year-old man is admitted through the Emergency Department after his wife found him unresponsive in their bedroom. He was surrounded by empty packets of paracetamol and amitriptyline. On assessment, he is found to be hypotensive and tachycardic, with sluggish pupillary responses. A 12-lead ECG shows a wide-complex tachycardia (QRS complex 140 ms) with a large terminal R wave in the augmented Vector Right (aVR) lead. He is given treatment intravenously with treatment X. A repeat ECG reveals a sinus tachycardia with a QRS complex duration of 92 ms.
Which of the following is most likely to represent treatment X?

MSFinals-4811

A 27-year-old woman presents to the Emergency department with a suspected intentional overdose. She is unsure of the medication she has taken. Her medical history includes severe asthma, anxiety, and depression. Additionally, she is a regular cannabis smoker.

During the assessment, the patient appears agitated and confused, unable to remain still on the bed. There is significant global hypertonia and clonus, particularly in the legs. Her vital signs reveal a sinus tachycardia on ECG with a pulse of 135 bpm. Her blood pressure is 156/96 mmHg, SpO2 97% on air, respiratory rate of 32, and temperature of 40.6°C. The patient’s pupils are dilated, and she is sweating.

Which medication is the patient likely to have overdosed on?

MSFinals-4812

A 62-year-old patient visits their dentist complaining of jaw pain and non-healing gingival lesions with visible areas of the mandible. The patient has recently started taking a new medication. Which drug could be causing these symptoms?

MSFinals-4813

A 16-year-old boy with learning difficulties was brought in by ambulance with his carer, he was found lying on the floor at home. He was suspected of having taken some pills at home as the carer found an empty bottle next to him. On arrival, he is very agitated with his jaw clenched, there is also involuntary upward deviation of his eyes.
Which of the following drugs is most likely the causative agent?

MSFinals-4814

A 26-year-old known epileptic patient presents with a 4-day history of unsteadiness and altered vision. Co-workers have noticed that he seems intoxicated while on the job. He had visited Neurology Outpatients 3 weeks ago. During the examination today, he displays a wide-based gait, past pointing, and intention tremor.
Which medication is the most probable cause of these symptoms?

MSFinals-4815

A 26-year-old graduate student presents to the emergency department with a headache that has been ongoing for 8 hours. He reports feeling nauseous and has vomited once. The headache developed gradually over an hour, and he has been in bed with the curtains drawn all day. His housemates are all well. He has a history of smoking one pack of cigarettes a day and drinking 6-7 mugs of instant coffee. On examination, he has photophobia and is unable to tolerate a full cranial nerve examination. There is no nuchal rigidity. His vital signs are within normal limits, and his arterial blood gas shows a pH of 7.39, PaO2 of 11 kPa, PaCO2 of 5.6 kPa, cHCO3 of 23 mmol/L, and COHb of 8%. What is the most likely cause of his symptoms?

MSFinals-4816

You are informed that a new antihypertensive has been linked to spontaneous reports of upper gastrointestinal haemorrhage in elderly patients. The MHRA has received 60 yellow card cases, and it is estimated that 120,000 people aged 65 and above have used the medication since launch. The clinical programme for the development and registration of the drug involved 3,800 elderly subjects. What is the most suitable study to investigate this adverse event?

MSFinals-4817

As a part of a study on the patterns of antibiotic resistance, the mechanisms of actions of various antibiotics and how this affects resistance is observed.

Which one of the antibiotics below acts by inhibiting protein synthesis, for a research project aimed at a younger audience?

MSFinals-4818

A 68-year-old man comes to you with a severe sunburn-like reaction on his face after spending a few hours in the garden the previous day. He was prescribed an antibiotic for a urinary tract infection a few days ago. Upon examination, you notice a severe erythematosus reaction with the formation of several vesicles on all sun-exposed areas. The following investigations were conducted:

Investigation Result Normal value
Haemoglobin 130 g/l 135–175 g/l
White cell count (WCC) 8.5 × 109/l (neutrophils 6.2) 4–11 × 109/l
Platelets 320 × 109/l 150–400 × 109/l
Sodium (Na+) 142 mmol/l 135–145 mmol/l
Potassium (K+) 5.0 mmol/l 3.5–5.0 mmol/l
Creatinine 145 μmol/l 50–120 µmol/l
Skin biopsy Necrotic keratinocytes

Which antibiotic is most likely responsible for this reaction?