Archives: Medical Student Finals

MSFinals-2211

A 32-year-old construction worker has had a fall from scaffolding at work and you suspect a midshaft humeral fracture. Which nerve would be most at risk in this scenario?

MSFinals-2212

A 65-year-old gentleman has been under your care for an acute exacerbation of COPD. It is his second admission for his COPD in the last twelve months and has had one previous ITU admission.

So far on the ward, he has received treatment with back-to-back salbutamol and ipratropium nebulisers, oral prednisolone and intravenous theophylline. He is also receiving a course of intravenous co-amoxiclav and clarithromycin due to a suspected infectious cause.

His latest results are as follows:

Obs:
BP 140/92 mmHg
HR 90/min
RR 24/min
SaO2 80%
Temp 38.2ºC

Arterial Blood Gas:
pH 7.30
PaO2 7.8 kPa
PaCO2 9.5 kPa
HCO3- 36 mmol/L
BE +5

What is the main indicator for initiating non-invasive ventilation in this patient?

MSFinals-2213

A 27-year-old woman visits the sexual health clinic and reports having had unprotected sex with 7 male partners in the past 5 months. She is currently taking hydroxychloroquine for systemic lupus erythematosus, the progesterone-only pill for contraception, and azathioprine for Crohn’s disease. Her test results show negative for trichomoniasis and HIV, but positive for VDRL syphilis and negative for TP-EIA syphilis. What is the most likely interpretation of these findings?

MSFinals-2214

You see a 50-year-old male patient for discussion of his recent oral glucose tolerance test. He has a family history of type 2 diabetes and he wanted to be tested for it. He has no symptoms. You inform him that based on the result of his oral glucose tolerance test, he has impaired glucose tolerance. What is the accepted definition of impaired glucose tolerance?

MSFinals-2181

A 56-year-old male presents to the emergency department with a sudden onset of sharp chest pain on the left side and difficulty breathing. He has a medical history of COPD and uses a salbutamol inhaler. Upon examination, there is decreased chest expansion and breath sounds on the left side, as well as hyper-resonance on percussion. A chest x-ray reveals a 2.1 cm left-sided pneumothorax at the lung hilum. What is the next step in managing this patient?

MSFinals-2182

A 28-year-old woman visits her GP and experiences a convulsive episode involving her entire body while in the waiting room. She is unable to speak during the episode but can make eye contact when her name is called. Following the episode, she quickly returns to her normal state and can recall everything that occurred. Her medical history includes alcohol overuse and post-traumatic stress disorder. What is the probable diagnosis?

MSFinals-2183

A 35 year old female patient visits her GP clinic complaining of recent paresthesia in her left leg. She was diagnosed with multiple sclerosis 4 months ago by the neurology department. The paresthesia has been ongoing for 3 days and is accompanied by increased fatigue and urinary frequency/urgency symptoms. A urine dip test shows no abnormalities. What is the most suitable treatment to initiate in this scenario?

MSFinals-2184

A 63-year-old male was admitted to the intensive care unit 2 weeks ago following an anterior myocardial infarction secondary to severe microcytic anaemia. Today, he appears drowsy and on assessment, bilateral basal crackles and reduced air entry are discovered. The observations and monitor values are given below:

Oxygen saturation: 85% on 2L oxygen via nasal specs.
Respiratory rate: 30 breaths per minute.
Pulse rate: 105 beats per minute.
Temperature: 36.8 Celsius.
Blood pressure (via arterial line): 100/60 mmHg.
Pulmonary capillary wedge pressure: 28 mmHg (2 – 15 mmHg).

His arterial blood gas (ABG) is given below:

pH 7.24 (7.35-7.45)
PaO2 10.2 kPa (10 – 13 kPa)
PaCO2 7.3 kPa (4.6 – 6.1 kPa)
HCO3- 22 mmol/L (22 – 26 mmol/L)
Glucose 6.8 mmol/L (4.0 – 7.8 mmol/L)

His chest x-ray shows bilateral ill-demarcated fluffy opacification, especially around the hilar regions, with a horizontal, sharp white line in the right mid-zone.

What is the most likely diagnosis, given the above?

MSFinals-2185

Which type of neurone has its cell body situated in the central nervous system and is primarily responsible for connecting other neurones?