Archives: Medical Student Finals

MSFinals-4767

A 36-year-old woman has experienced a stillbirth and wants to stop lactation. What medication should be used for this purpose?

MSFinals-4768

A 75-year-old man is admitted to the hospital with abdominal pain and confusion that has been worsening for the past 5 days. He has also experienced a decline in vision, with reduced acuity and altered colour perception. The patient had recently suffered from vomiting and diarrhoea, which had affected many others at his nursing home. Staff report that he has produced very little urine since then. The patient has a medical history of atrial fibrillation, hypertension, hypercholesterolaemia, and depression. His blood tests reveal Hb 185 g/l, platelets 435 * 109/l, WBC 11 * 109/l, Na+ 144 mmol/l, K+ 5.3 mmol/l, urea 28 mmol/l, and creatinine 170 µmol/l. Can you identify which of his regular medications may be causing his current presentation?

MSFinals-4769

A 30-year-old female is brought to the emergency department by ambulance after being found collapsed on the streets. She appears confused, ataxic, and is slurring her speech. The patient is very emotional and does not respond to any questions. The initial assessment reveals tachycardia and hypertension. Glasgow Coma Scale (GCS) score = 13 (E4V4M5). An ABCDE approach is taken to stabilize the patient, and an arterial blood gas (ABG) and blood test are carried out.

The results of the blood test are as follows:
– pH 7.28
– pCO2 3.6 kPa
– pO2 11.4 kPa
– HCO3- 20 mmol/L
– Na+ 132 mmol/L
– K+ 4.1 mmol/L
– Chloride 94 mmol/L
– Glucose 4.1 mmol/L
– Urea 7.7 mmol/L
– Ethanol 20 mmol/L ( <17.4 mmol/L)
– Serum osmolality 301 mOsm/kg (275-295 mOsm/kg)

Note: The estimated serum osmolality can be calculated as 2 x (Na+ + K+) + urea + glucose + (ethanol/4). Normal osmolar gap = -3 to 10. Normal anion gap = 10-18 mmol/L (assuming K+ is used as part of the calculation).

What is the most likely cause of this patient’s presentation?

MSFinals-4772

A 68-year-old man with a history of chronic kidney disease stage 4 and metastatic prostate cancer is admitted with a swollen left calf. Investigations confirm a deep vein thrombosis and he is started on treatment dose dalteparin. As he has a significant degree of renal impairment it is decided to monitor his response to dalteparin. What is the most suitable blood test to conduct?

MSFinals-4773

A 24-year-old female patient presents at the clinic with a complaint of intense menstrual cramps. Despite taking the maximum recommended doses of ibuprofen and paracetamol, she has not experienced much relief. As a healthcare provider, you opt to prescribe a course of hyoscine tablets. Can you explain the mechanism of action of hyoscine?

MSFinals-4774

Which of the following statements about the use of aspirin in patients with ischemic heart disease is accurate?

MSFinals-4775

A 55-year-old man is recovering from a coronary artery bypass surgery and is about to come off the cardiac bypass circuit. What medication should be given to restore the patient’s clotting function before closing the chest and removing the cannula?

MSFinals-4776

A 75-year-old man with a history of ischaemic cardiomyopathy and atrial fibrillation is admitted to the hospital due to vomiting caused by norovirus. His blood tests from 2 months ago were as follows:
– Sodium (Na+): 136 mmol/L (135 – 145)
– Potassium (K+): 4.0 mmol/L (3.5 – 5.0)
– Urea: 7.8 mmol/L (2.0 – 7.0)
– Creatinine: 120 µmol/L (55 – 120)

However, his blood tests today show:
– Sodium (Na+): 130 mmol/L (135 – 145)
– Potassium (K+): 2.8 mmol/L (3.5 – 5.0)
– Urea: 10.2 mmol/L (2.0 – 7.0)
– Creatinine: 140 µmol/L (55 – 120)
– Digoxin level: 3.1 ng/ml (0.8-2.0)

Which of his regular medications is likely responsible for his digoxin toxicity?