Archives: Medical Student Finals

MSFinals-6430

A 25-year-old motorcyclist is brought into resus after a bike versus lorry road-traffic collision. Following a primary survey, he is believed to have multiple lower limb fractures. He is scheduled for a trauma CT scan. While preparing for transfer to the imaging department, the patient becomes agitated and lashes out at the nurse caring for him. The patient has become more confused and tries to bite the doctor who has attended to review him. A decision is made to intubate the patient to prevent them from causing further self-inflicted injuries.
What medication would be most appropriate to use?

MSFinals-6431

You have been requested to evaluate a 40-year-old man who recently underwent a cholecystectomy with general anaesthesia. Although the procedure was uneventful, he has developed vomiting, headache, and flank pain. Upon examination, he displays weakness in his limbs, a capillary refill time of 6 seconds, and a blood pressure of 98/43 mmHg. His 8am cortisol level is 1.5µg/dL (normal range: 10-20µg/dL), and his ACTH level is 140ng/dL (normal range: >100ng/dL). What is the most probable cause of his symptoms?

MSFinals-6432

You are a member of the surgical team and are currently attending to a 36-year-old female patient who has been involved in a car accident. She has sustained a fractured femur and is experiencing chest pain. Her medical history reveals that she has asthma which has been poorly controlled. The patient has been admitted for surgical repair and is receiving general anesthesia, nitrous oxide, and an epidural for pain relief. However, you have noticed that her breathing is becoming more labored and she is complaining of chest pain. Upon checking her vital signs, you observe that her respiratory rate is 30 breaths per minute, blood pressure is 70/50 mmHg, heart rate is 150 beats per minute, and temperature is 37ºC. During your examination, you also notice that her left chest is hyper-resonant. What is the most likely cause of her deterioration?

MSFinals-6433

A 55-year-old woman visits her doctor with a lump in her left breast that she noticed a month ago and believes has grown in size. She had her last menstrual period two years ago. Upon examination, a painless, firm nodule is found in her left breast. She is urgently referred for triple assessment and is diagnosed with invasive ductal carcinoma. Molecular subtyping of the cancer is performed as part of the diagnostic work-up, revealing that she is ER and PR positive, but HER2 negative. What is the most likely treatment for this woman?

MSFinals-6434

A 45-year-old female patient complains of a painless lump in her right groin. She denies any changes in bowel habits or abdominal discomfort. Her medical history includes asthma and three previous vaginal deliveries. Upon examination, a soft swelling is palpable with a positive cough impulse. The lump is located inferolateral to the right pubic tubercle, fully reducible, and non-tender. Both femoral pulses are palpated separately and are normal. What is the best course of action for managing this patient’s condition?

MSFinals-6435

A 47-year-old man is scheduled for an elective repair of a left-sided inguinal hernia under general anesthesia. What advice should he be given regarding eating and drinking before the surgery?

MSFinals-6436

A 56-year-old man arrives at the emergency department after sustaining a head injury. He tripped over a rake in his backyard and hit his head on a tree trunk about an hour ago. He vomited once immediately after the incident and again on his way to the hospital. He has no other symptoms and is not taking any medication.

Upon examination, he is responsive and spontaneously opens his eyes. He has normal limb movement. His pupils are equal and react to light. There are no visible external injuries.

What is the most appropriate course of action for imaging?

MSFinals-6437

A 67-year-old man presents to the emergency department after a head injury. Four hours ago, he fell down the stairs and hit his head on the banister. He cannot recall what happened in the 30 minutes after the incident, but has no issues with memory of events leading up to the incident and no current memory problems. He denies any other symptoms. Upon examination, he responds and opens his eyes spontaneously, and is able to move all limbs normally. His pupils are equal and reactive to light, and there are no external signs of injury. What imaging study should be ordered?

MSFinals-6438

A 56-year-old plumber visits his family doctor complaining of a lump in his groin. He has a medical history of chronic obstructive pulmonary disease and no prior surgeries or medical issues. The lump has been present for three weeks, causes mild discomfort, and has not increased in size. During the physical examination, a soft, reducible lump is observed on the left side, located above the pubic tubercle, without skin changes. The doctor suspects an indirect inguinal hernia. What test would confirm this diagnosis?

MSFinals-6439

A 23-year-old male visits his GP complaining of natal cleft pain, along with purulent and bloody discharge from the area. He also has a fever. This is not the first time he has experienced these symptoms, as he has had similar episodes over the past three years. Typically, the symptoms resolve on their own, but return after a period of being asymptomatic. However, he underwent incision and drainage for his condition six months ago, and the symptoms have returned once again. What is the most effective treatment option for this individual?