Archives: Medical Student Finals

MSFinals-4750

A 56-year-old woman presents to the ear, nose and throat clinic with complaints of a dry mouth. She reports occasional dry, gritty eyes, but not at the time of the consultation. She denies any sore throat, ear pain or persistent change in her voice. She smokes four cigarettes per day and drinks a bottle of wine most weekends. She suffers from sciatica and takes amitriptyline at night. She is not on any other medications. She works as a head teacher in a stressful environment and the dryness is affecting her speech when addressing her students. Examination of the oral cavity and neck is unremarkable.
What is the most appropriate management plan for this 56-year-old woman?

MSFinals-4751

A 47-year-old woman presents with a 4-month history of low mood, fatigue, and weight gain. She has constantly felt cold during this time. This is her first presentation with these symptoms and she has noticed them after starting a new medication for her hypertension.

She has a past medical history of hypertension and takes amlodipine, lisinopril, and hydrochlorothiazide.

Investigations are performed:
Thyroid-stimulating hormone (TSH) 19.2 mU/L (0.5 – 5.5)
Free T4 1.8 pmol/L (9-18)

What is the most appropriate step in her management?

MSFinals-4752

A 25-year-old woman presents to the Emergency Department, having taken an overdose of paracetamol 12 h earlier. She claims that she took 30 500-mg tablets. She took the tablets along with half a litre of vodka and states that she does not normally drink alcohol. She appears to have mild alcohol intoxication.
What is the most appropriate action to take in this case?

MSFinals-4753

A 65-year-old woman with a history of depression and non-paroxysmal atrial fibrillation is brought to the emergency department by her daughter after being found unconscious with an empty bottle of medication. She is disoriented and complains of feeling nauseous. Shortly after arriving at the hospital, she experiences visual hallucinations and yellowing of her vision.

The patient denies smoking or substance abuse and leads a sedentary lifestyle. On examination, her pulse is irregular with a rate of 70 beats per minute, blood pressure is 110/70 mmHg, and respiratory rate is 18 breaths per minute. An ECG shows frequent premature ventricular contractions and ventricular bigeminy.

What is the most likely diagnosis, and what management should be implemented for this patient?

MSFinals-4754

A 55-year-old diabetic man is scheduled for an elective incision and drainage of a groin abscess in the day surgery unit. He is typically well-managed on metformin. How should his diabetic control be managed during this procedure?

MSFinals-4755

A 25-year-old man presents to the emergency department 2 hours after ingesting approximately 70 of his mother’s blood pressure pills following a recent breakup. He reports feeling fatigued, experiencing heart palpitations, and noticing a yellow-green tint to his vision. The medical team conducts observations, an ECG, and urgent blood tests. The ECG reveals sinus tachycardia. Oxygen saturation on air is 98%, heart rate is 115, blood pressure is 130/85 mmHg, and respiratory rate is 16. The blood tests show hyperkalemia with a potassium level of 6.5 mmol/L (3.5 – 5.0). The appropriate definitive management, besides treating the hyperkalemia, is what?

MSFinals-4756

You are working in the emergency department when a patient with gross swelling of the tongue and lips following a bee-sting is brought in. The patient is haemodynamically compromised and showing signs of airway compromise, and you diagnose them with anaphylaxis. What is the correct life-saving treatment?

MSFinals-4757

A 72-year-old man with atrial fibrillation and heart failure is initiated on digoxin. What is the mode of action of digoxin?

MSFinals-4758

A 51-year-old man with schizoaffective disorder has been stabilized on haloperidol for the past 13 years. He expresses concern about a medication side-effect that began approximately two years ago but has worsened over time, despite taking breaks from the medication for up to three months. He describes involuntary facial movements such as lip smacking and excessive blinking. Assuming the patient is not on any other medications, what is the most probable issue he is experiencing?

MSFinals-4759

Among workers aged 18 to 30, which substance is most commonly associated with causing occupational accidents and injuries?