Archives: Medical Student Finals

MSFinals-6422

An 80-year-old woman presents to the emergency department with abdominal pain and distention. She has been feeling unwell for the past 4 hours and she has vomited three times. Her past medical history includes hypertension and an appendicectomy in her late 40s. On examination, her abdomen is distended but not peritonitic, with absent bowel sounds. Her electrolytes were assessed and are as follows:

Na+ 138 mmol/L (135 – 145)
K+ 3.6 mmol/L (3.5 – 5.0)
Bicarbonate 24 mmol/L (22 – 29)
Urea 4 mmol/L (2.0 – 7.0)
Creatinine 105 µmol/L (55 – 120)
Calcium 2.4 mmol/L (2.1-2.6)
Phosphate 1.1 mmol/L (0.8-1.4)
Magnesium 0.9 mmol/L (0.7-1.0)

What is the first-line management for her condition?

MSFinals-6423

A 35-year-old man is brought to the Emergency department following a house fire. He appears lethargic, but his cheeks have a pinkish hue and he seems to be well perfused. His blood pressure is 100/60 mmHg and his pulse is 95 and regular. Upon blood gas analysis, a CO level of 12% and metabolic acidosis with a pH of 7.15 are detected. What is the most suitable next step in management?

MSFinals-6401

A 50-year-old woman arrives at the Emergency Department complaining of cramp-like abdominal pain, nausea, and vomiting that started 4 hours ago. She describes the pain as intermittent and has experienced similar pain before, but not as severe as this time. The patient has a history of chronic obstructive pulmonary disease, which is well-controlled with inhalers, and has been a smoker for 25 pack years.

Her vital signs are heart rate 110/min, respiratory rate 20/min, blood pressure 130/84 mmHg, temperature 38.6ºC, and oxygen saturation of 99% on room air. Upon examination, the patient appears very ill and sweaty, with some yellowing of the eyes. Palpation of the abdomen reveals tenderness in the right upper quadrant.

What is the most likely cause of the patient’s symptoms?

MSFinals-6402

A 20-year-old female presents to the emergency department with a 3 day history of lower abdominal pain. She also complains of nausea and vomiting, and has not had a bowel movement for 24 hours. She has mild dysuria and her LMP was 20 days ago. She smokes 15 cigarettes a day and drinks 10 units of alcohol per week. On examination she is stable, with pain in the left iliac fossa. Urinary pregnancy and dipstick are both negative. What is the most likely diagnosis?

MSFinals-6403

A 65-year-old man comes to the Emergency Department with severe abdominal pain and haematemesis. Following initial resuscitation, an urgent CT scan shows a perforated duodenal ulcer. The surgical team schedules an emergency laparotomy, and he is transferred to the operating room. Due to his non-fasted state, the anaesthetist intends to perform a rapid sequence induction (RSI) using a depolarising muscle relaxant to minimize airway obstruction.
What is the appropriate drug to use in this situation?

MSFinals-6390

A 27-year-old woman comes to the clinic eight weeks after giving birth with a painful, swollen, and red right breast. During the examination, there is fluctuance in the upper outer quadrant of the right breast near the nipple areolar complex. The overlying skin is tender and red. What is the best course of action for this patient?

MSFinals-6391

A 25-year-old African woman has an open appendicectomy. Eight months later, she is examined for an unrelated issue. During abdominal examination, it is observed that the wound area is covered by shiny dark raised scar tissue that extends beyond the boundaries of the skin incision. What is the most probable underlying process?

MSFinals-6392

A 60-year-old man presents to the clinic with a groin swelling. During the physical examination, the general practitioner notes a soft, painless lump located superomedial to the pubic tubercle on the left side. The patient experiences a positive cough impulse, and bowel sounds are audible upon auscultation. There is no testicular swelling, and the scrotum feels normal upon palpation. The GP successfully reduces the lump. What further steps should the GP take in the clinical examination to determine the subtype and anatomy of this swelling?

MSFinals-6393

A 24-hour-old full-term neonate is attempting to feed from her mother, but is unable to keep anything down. The vomit appears green, indicating possible bile staining. The delivery was uncomplicated and vaginal. The neonate appears healthy and stable otherwise. What is the probable diagnosis?

MSFinals-6399

A 65-year-old man presents with urinary problems. He has been passing very frequent small amounts of urine and has also been getting up several times in the night to urinate.

Upon examination, he has a smooth, non-enlarged prostate, and no abdominal masses. Further investigation rules out diabetes, infection, and urological malignancy. It is determined that his symptoms are due to an overactive bladder. Lifestyle advice is discussed, and he is referred for bladder training exercises.

What should be the next course of action?