Archives: Medical Student Finals

MSFinals-4708

During a Monday lunchtime home visit, you encounter a 72-year-old patient with metastatic colon cancer who has been experiencing a decline in health over the past 2 months. The patient has extensive disease with liver and peritoneal metastatic deposits and also suffers from type II diabetes mellitus and moderately severe chronic obstructive pulmonary disease (COPD). To manage her pain, she takes ibuprofen 400 mg three times daily (tid), paracetamol 1 g four times daily (qds), morphine sulfate modified-release tablets (MST) 30 mg twice daily (bd), and Oramorph® 10 mg as required (prn). However, her abdominal pain has worsened over the weekend, and she has required three doses of Oramorph® per day in addition to her other analgesia. Although the dose is effective, the pain returns after about 2-3 hours. The patient is able to consume small amounts of food and fluid but appears to be in poor health with jaundice and quick, shallow breathing. What is the most appropriate treatment for her pain?

MSFinals-4709

A 79-year-old man with metastatic lung cancer is in hospice care. He is becoming weaker with loud audible breath sounds and a respiratory rate of 25 breaths per minute. He has a very weak cough.
Which of the following medications may be of most benefit?

MSFinals-4710

A 67-year-old woman attending Oncology has metastatic breast cancer with bony metastases in her pelvis and femur. She has hip pain at rest, not relieved by paracetamol and naproxen.
Which of the following analgesic options would be most specific for metastatic bone pain?

MSFinals-4711

You are assessing an 85-year-old woman with advanced dementia who is bed-bound and has a grade two pressure ulcer. Her carer thinks she feels pain when being moved in bed. The patient takes no pain medication at present. The patient is having severe nausea, vomiting and has severely impaired mental status.
Which of the following is the most appropriate prescription?

MSFinals-4700

A 75-year-old man with a history of metastatic lung cancer presents with severe bony pain. Despite being treated with increasing doses of opioids as an outpatient, he now reports experiencing intense pain in his right shoulder that worsens with movement. This pain is distinct from the metastatic bone pain he has been experiencing in his lower limbs. There is no history of trauma. What would be the most suitable course of action to take next?

MSFinals-4685

A 35 year old pregnant woman undergoes routine pregnancy screening blood tests and is found to have an elevated alpha-fetoprotein level. This prompts investigation with ultrasound scanning. The scan reveals a fetus with an anterior abdominal wall defect and mass protruding through, which appears to still be covered with an amniotic sac.
What is the standard course of action for managing this condition, based on the probable diagnosis?

MSFinals-4686

A 3-year-old girl is presented to the clinic by her mother complaining of ear pain and fever. During the examination of the chest, a murmur is detected. Which of the following features is not in line with an innocent murmur?

MSFinals-4687

A murmur is incidentally discovered by a GP in a 9-year-old girl. The murmur is described as a ‘continuous blowing noise’ heard below both clavicles. What type of murmur is most likely to be diagnosed?

MSFinals-4688

You are attending labour for an emergency Caesarean section for failure to progress. The operation goes on without any complications. The baby cries immediately after birth and there is 30 seconds of delayed cord clamping. On examination, baby is centrally pink with blueish hands and feet. Saturation probes are attached to the baby and show an oxygen saturation of 73% at 5 minutes. What is the most appropriate next step in management?

MSFinals-4689

A 4-month old baby presents with a murmur and cyanosis. What is the most probable diagnosis?