Archives: Medical Student Finals

MSFinals-6385

A 36-year-old woman presents to the Emergency Department complaining of central, tearing chest pain that is not radiating. She reports having food poisoning and vomiting every hour for the past day. She describes the vomit as liquid without blood. The patient is alert, appears thin, and has dry mucous membranes. She has no relevant medical or family history, is a non-smoker, drinks 8 units of alcohol per week, and works as a cleaner. During ECG placement, the doctor notices crepitus over her chest wall, and the ECG reveals sinus tachycardia. What is the most likely cause of her symptoms?

MSFinals-6386

A 50-year-old man arrives at the emergency department with a friend. The man appears drowsy and has a strong smell of alcohol. According to his friend, he complained of sudden, severe retrosternal pain that worsened when swallowing. The patient has a history of alcoholic liver disease. His vital signs include a heart rate of 130/min, respiratory rate of 24/min, temperature of 37.7ºC, oxygen saturation of 98%, and blood pressure of 100/74 mmHg. Upon examination, there are crackles heard on auscultation of his chest wall, and dried vomit is present around his mouth. An ECG shows sinus rhythm. What is the most likely diagnosis?

MSFinals-6387

A father on the pediatric ward tells the doctor that his 2-year-old child has been having trouble with their feeds and has been vomiting a green substance. The child was born at term via vaginal delivery. On examination, the abdomen is soft but appears to be distended. An abdominal x-ray is ordered, which shows a ‘double bubble’ sign. What is the most probable diagnosis?

MSFinals-6388

A 55-year-old woman comes to the clinic with a complaint of bloody discharge from her left nipple. She is also a perimenopausal woman who has two grown children that were born after normal labour and delivery and breastfed. She is not currently taking hormone replacement therapy. Upon physical examination, there are no signs of lumps, asymmetry, or dimpling of the skin or nipple. When pressure is applied to the nipple, a small amount of bloody fluid is expressed. What is the probable cause of her presenting symptom?

MSFinals-6389

A 25-year-old man visits his GP with a concern about a painless lump in his scrotum and bilateral breast enlargement. What would be the most suitable initial test for the probable diagnosis?

MSFinals-6353

A 55-year-old man is 1 week post right-hemicolectomy for colorectal cancer and formation of ileostomy. He reports experiencing intermittent shortness of breath and an arterial blood gas sample was taken, revealing the following results outside of normal range:
pH: 7.25 (7.35 – 7.45)
pO2: 11.1 (10 – 14)kPa
pCO2: 3.2 (4.5 – 6.0)kPa
HCO3: 11 (22 – 26)mmol/l
BE: -15 (-2 to +2)mmol/l
Na: 110 135-145 mmol/l
K: 3 3.5-5 mmol/l

What are the possible differential diagnoses for this patient based on the given information?

MSFinals-6358

A 50-year-old man is involved in a high-speed car accident and suffers from severe injuries. During the initial assessment, it is discovered that he has free fluid in his abdominal cavity on FAST scan. Due to his unstable condition, he is taken to the operating theatre for laparotomy. The surgeons identify the main sources of bleeding in the mesentery of the small bowel and tie them off. The injured sections of the small bowel are stapled off but not reanastamosed. However, there are multiple tiny areas of bleeding, especially in the wound edges, which the surgeons refer to as a general ooze. The abdomen is closed, and the patient is admitted to the intensive care unit. The surgeons plan to return to the theatre to repair the small bowel 24 hours later when the patient is more stable. What is the principle of damage control laparotomy?

MSFinals-6359

An 80-year-old man is experiencing abdominal pain, bloating, and nausea while on the ward. He underwent an emergency laparotomy for a perforated diverticulum four days ago. The patient has already vomited twice this morning and has not had a bowel movement since the surgery. Upon examination, his abdomen is significantly distended with tenderness throughout. Bowel sounds are reduced, but vital signs are normal. What is the probable cause of his symptoms?

MSFinals-6360

A 26-year-old male is in need of immediate surgery after suffering from traumatic injuries to his right leg in a car accident. He has a family history of malignant hyperpyrexia and last consumed solid food 2 hours ago.
What would be considered unsafe for administration in this patient?

MSFinals-6361

As you approach the bedside of an elderly overweight woman, you notice that she appears to be quite drowsy. Upon calling out her name, you hear a grunting noise and quickly call for the nurse’s assistance. The patient’s oxygen saturations are at 82% on air.

What would be the immediate next step in managing this patient?