Archives: Medical Student Finals

MSFinals-2201

A 28-year-old man presents to the emergency department with difficulty swallowing and blurred vision. He is worried about his slurred speech which started the day before. He has no past medical history or current medications.

Upon examination, the patient appears disheveled and has multiple track marks on both arms with surrounding redness. His vital signs are normal. Cranial nerve examination reveals bilateral ptosis, diplopia, impaired pupil accommodation, and impaired gag reflex. The patient’s speech is also slurred. Upper limb examination shows hypotonia and 4/5 power bilaterally, while sensation is intact. Lower limb examination is unremarkable.

What is the most likely causative organism for this patient’s presentation?

MSFinals-2202

A 57-year-old woman visits her GP complaining of shortness of breath and a cough with green sputum for the past week. She has no known drug allergies and is not taking any medication. Upon examination, her respiratory rate is 18/min, and her oxygen saturation is 95%. Her blood pressure is 126/74 mmHg, and her pulse rate is 84 bpm. She has a body temperature of 37.8 ºC. A chest x-ray is ordered. What is the most appropriate drug treatment for the likely diagnosis?

MSFinals-2203

A 25-year-old man is brought to the emergency department after being submerged. Upon arrival, the patient is found to be in ventricular fibrillation (VF) on ECG and has a temperature of 26 degrees centigrade. You have already administered three defibrillation shocks and initiated active and passive rewarming, but the patient remains in VF. What should be your next steps in managing this patient?

MSFinals-2204

A 72-year-old man presents to his GP with frequent blood pressure readings above 160/95 mmHg on an ambulatory monitor. He has a history of well-controlled heart failure (New York Heart Association stage 2) and chronic kidney disease. The patient is currently taking ramipril, bisoprolol, and atorvastatin, with optimized dosages for the past year.

What is the most suitable course of action to take next?

MSFinals-2205

A 28-year-old female patient arrives the day after ingesting an overdose of paracetamol. She appears to be dehydrated, and the house officer initiates an infusion while awaiting the results of her blood tests. What blood test result would indicate the need for liver transplantation referral?

MSFinals-2206

An elderly woman, aged 76, visits her GP complaining of breathlessness and leg swelling. She has a medical history of heart failure (ejection fraction 33%), rheumatoid arthritis, and type 2 diabetes mellitus. Her current medications include 7.5mg bisoprolol once daily, 10 mg lisinopril once daily, 20 mg furosemide twice daily, 500 mg metformin three times daily, and 1g paracetamol four times daily. During the examination, the GP notes mild bibasal crackles, normal heart sounds, and bilateral pedal pitting oedema. The patient’s vital signs are heart rate 72 beats per minute and regular, respiratory rate 18 breaths per minute, oxygen saturations 94% on room air, blood pressure 124/68 mmHg, and temperature 36.2oC. The patient’s blood test results from two weeks ago show Na+ 140 mmol/L (135 – 145), K+ 4.2 mmol/L (3.5 – 5.0), Bicarbonate 23 mmol/L (22 – 29), Urea 6.2 mmol/L (2.0 – 7.0), and Creatinine 114 µmol/L (55 – 120). What would be the most appropriate medication to initiate?

MSFinals-2207

Which one of the following statements regarding hepatitis A is not true?

MSFinals-2208

A 22-year-old woman presents to the emergency department with abdominal pain and nausea. She has a distinct ‘pear drops’ odor on her breath. The medical team admits her and initiates aggressive IV fluid replacement and insulin therapy as per national protocol. Despite being clinically stable after 24 hours, she is unable to eat or drink.
Her vital signs are as follows:
– Heart rate: 110 bpm
– Respiratory rate: 15/min
– Blood pressure: 122/90 mmHg
An arterial blood gas test reveals a pH of 7.28, and her blood results show:
– Plasma glucose: 15.6 mmol/L
– Sodium: 136 mmol/L (135 – 145)
– Potassium: 4.6 mmol/L (3.5 – 5.0)
– Bicarbonate: 13 mmol/L (22 – 29)
– Ketones: 4.5 mmol/L (<3)
What is the most appropriate next step in managing this patient’s condition?

MSFinals-2209

As a Foundation Year 2 doctor on a four month rotation at an Emergency department, you encounter a 54-year-old female with a history of rheumatoid arthritis. She presents with a two month history of dry mouth and itchy eyes, as well as a three day history of painful eyes and sensitivity to bright light. Despite her well-controlled rheumatoid arthritis with methotrexate and sulfasalazine, she requires NSAIDs for symptomatic relief. Upon examination, you observe a dry oral cavity and a few corneal abrasions on her right eye, but the sclera is otherwise white. Her pupil is normal and visual acuity tests are unremarkable. A bedside Schirmer’s test reveals 3 mm of diffusion on filter paper bilaterally. What is the most likely diagnosis?

MSFinals-2210

A 39-year-old man presents to the emergency department with multiple episodes of forceful retching resulting in the expulsion of approximately 3 tablespoons of blood. He reports consuming 24 units of alcohol daily for the past week due to job loss. Although his Glasgow coma score is 15, he complains of dizziness. His vital signs include a blood pressure of 105/68 mmHg, pulse rate of 105 bpm, oxygen saturations of 98%, respiratory rate of 20 breaths per minute, and fever.
Currently, blood tests and results are pending. What is the most crucial step in managing this patient?