Archives: Medical Student Finals

MSFinals-2268

A 67-year-old man arrives at the emergency department complaining of severe central chest pain. He has a history of hypertension and takes amlodipine, and he is a heavy smoker, consuming 40 cigarettes per day. Upon examination, his heart rate is 115 bpm, his blood pressure is 163/96 mmHg, his oxygen saturations are 97%, and his respiratory rate is 20 /min. He appears sweaty and in pain, and a cardiovascular examination is unremarkable. An ECG reveals sinus tachycardia and tall R waves and ST depression in V1 and V2. Blood tests are conducted, showing Hb 140 g/L (135 – 180), platelets 160 * 109/L (150 – 400), WBC 5.0 * 109/L (4.0 – 11.0), and Troponin I 1.50 ng/mL (0.00 – 0.04). What is the most probable cause of this man’s presentation?

MSFinals-2269

A 32-year-old man visits the sexual health clinic following unprotected sex with a female partner. He reports experiencing coryzal symptoms and myalgia, which began four weeks ago. The patient has a history of asthma, which is managed with salbutamol. The doctor advises him to undergo HIV testing, and he consents. What is the best course of action for managing his condition?

MSFinals-2234

A 54-year-old woman presents to the medical admissions unit with complaints of breathlessness. Her GP had noted reduced breath sounds and dullness to percussion at the left lung base. An urgent chest X-ray reveals a left-sided pleural effusion. To identify the cause of the effusion, an aspirate of the pleural fluid is taken, and the results show a pleural effusion fluid protein/serum protein ratio of 0.73. What is the probable reason for the pleural effusion?

MSFinals-2235

A 16-year-old male presents to the nephrology unit with a complaint of recurrent visible haematuria following upper respiratory tract infections. He denies any abdominal or loin pain. The urine dipstick is unremarkable, and blood tests reveal normal electrolyte levels and kidney function. What is the probable diagnosis?

MSFinals-2236

A 65-year-old patient presents with central chest pain and is diagnosed with non-ST elevation myocardial infarction. Aspirin and fondaparinux are administered. What is the mode of action of fondaparinux?

MSFinals-2237

A 35-year-old male patient visits his GP complaining of a rash and fever that have been present for three days. He has a maculopapular rash on his trunk and palms, along with palpable lymph nodes in his groin and axilla. Additionally, he has mouth ulcers and flat white wart-like lesions around his anus. What is the recommended treatment for this patient?

MSFinals-2238

A 65-year-old male with non-Hodgkin lymphoma (NHL) presents to the emergency department complaining of fever, chills, and feeling generally unwell. Upon examination, his temperature is 38.6ºC, pulse rate is 116 beats/min, blood pressure is 102/62 mmHg, and respiratory rate is 24 beats/min. Crackles and bronchial breathing are heard in the left upper zone of his chest. A urine dip is negative for leucocytes and blood tests reveal a neutrophil count of 0.4. He received his last cycle of chemotherapy 10 days ago. What is the most appropriate antibiotic treatment to initiate for this patient?

MSFinals-2239

A 65-year-old man arrives at the emergency department by ambulance after experiencing speech difficulties four hours prior. He has a medical history of hypertension, atrial fibrillation, and high cholesterol, and takes atorvastatin and ramipril regularly. Despite having atrial fibrillation, he chose not to receive anticoagulation therapy. He smokes ten cigarettes per day, drinks alcohol occasionally, and works as a language school director.

During the examination, the patient displays expressive dysphasia and exhibits right-sided hemiplegia, sensory loss, and homonymous hemianopia. Urgent CT head and CT angiography reveal no intracranial hemorrhage but do confirm occlusion of the proximal anterior circulation.

What is the most appropriate course of action?

MSFinals-2240

A 35-year-old woman presents to the emergency department with a 24-hour history of fever, headache, and neck stiffness. She has no significant past medical history and no allergies.

Her vital signs are currently stable, and there are no visible rashes on examination. The patient is fully alert and oriented with a GCS of 15/15.

After consulting with a senior physician, it is determined that a lumbar puncture is necessary. However, due to departmental constraints, it is unlikely that the procedure can be performed within the next hour.

What is the most appropriate next step in managing this patient?

MSFinals-2241

A 28-year-old man presents to the emergency department with vague abdominal pain, nausea, and vomiting. He has a history of alcohol abuse and depression, and has been feeling particularly low following a recent breakup. He has not been eating much in the past few days.
Observations: heart rate 94 beats per minute, blood pressure 110/70 mmHg, respiratory rate 18 breaths per minute, temperature 37.2ºC, oxygen saturations 99% on air.
Initial investigations are done including a capillary glucose, capillary ketones, arterial blood gas and electrocardiogram(ECG).
ECG: sinus tachycardia
Capillary glucose 4.8 mmol/L (4-7)
Capillary ketones 3.5 mmol/L (0-0.6)
pH 7.34 (7.35-7.45)
pO2 13 kPa (10-14)
pCO2 4.5 kPa (4.5-6)
Lactate 1.7 mmol/L (0-2)
What is the most appropriate management plan at this point?