Archives: Medical Student Finals

MSFinals-1254

An 88-year-old man is brought to the Emergency Department (ED) via ambulance with central crushing chest pain. An electrocardiogram (ECG) in the ambulance shows 3 mm ST elevation in the anterior leads consistent with a STEMI. His wife says he has a history of ischaemic heart disease and congestive cardiac failure. He has a cardiac arrest in the ED secondary to ventricular fibrillation. Despite resuscitation using advanced cardiac life support, he dies. His wife asks what will happen to his body.
What is the most appropriate next step in management for this deceased patient?

MSFinals-1255

A 93-year-old man was admitted to your medical ward in Scotland a week ago, having developed pneumonia. He has a history of dementia, has had two previous small strokes and lives in a residential home. His dementia has been worsening for 5 years. He has difficulty remembering who the nursing home staff are. The staff report that his appetite is poor and that he has gradually lost weight over the last few months.
He is treated with antibiotics with good effect. A week later, a swallowing assessment is performed by the speech and language therapist, which suggests a high risk of aspiration. As a result of this assessment, the care team wish to stop him taking food and drink by mouth and start intravenous (IV) fluids.
How should you proceed next?

MSFinals-1256

A 78-year-old man with a history of dementia was admitted to your medical ward from a nursing home in Scotland a week ago. A swallow assessment was performed after the patient was noticed to have difficulty eating and drinking; which concluded that the patient was at high risk of aspiration. The care team therefore wish to make him nil by mouth and start intravenous (IV) fluids. You have explained the situation to him and asked for his consent, which he refused. You are not content that he has fully understood the gravity of the situation, as a result of his dementia. You note that the patient does not have a welfare attorney or guardian with power to consent.
Which of the following would be the most appropriate way to proceed in this scenario?

MSFinals-1257

At 1700 h, you are tasked with seeing a 15-year-old girl who has recently been diagnosed with leukaemia and admitted to a major hospital in England. The patient’s current vital signs include a heart rate of 120 per minute, a gallop rhythm, and a soft murmur. Additionally, her Hb level is at 6.5. However, the patient’s parents are refusing a blood transfusion due to their religious beliefs. What course of action do you take?

MSFinals-1258

A 55-year-old man was admitted to hospital two weeks ago, having collapsed at home. He has a history of hypertension and coronary artery disease and has suffered a myocardial infarction (MI) in the past. During admission, he was found to be short of breath and tachycardic, with an irregular heart rate. His electrocardiogram (ECG) showed a narrow complex tachycardia, with absent P waves. He is now medically fit for discharge.
What advice should you give to this patient about driving?

MSFinals-1259

An 88-year-old woman with metastatic squamous cell lung cancer is admitted with lower respiratory tract infection on a background of recurrent infection. She is not undergoing any active cancer treatment. She lives at home alone. The admitting consultant discusses her wishes with regards to her future care. The consultant assesses the patient, notes that she has capacity and the patient asks for a ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) form, which is filed in her medical notes. She is adamant that she does not want CPR; however, her daughters arrive and are extremely angry when they hear she has signed a DNACPR. They meet the consultant and express their wishes for the DNACPR order to be revoked and for the patient to undergo resuscitation in the event of cardiopulmonary arrest.

Which of the following is true with regards to the DNACPR order?

MSFinals-1260

You are a high school student on a busy school day. You were up most of the night due to diarrhoea and vomiting (D&V). You feel you have food poisoning but know your classmates need you for group projects and presentations.
What is the most appropriate action to take?

MSFinals-1261

A 6-month-old boy is brought to the Emergency Department by his concerned parents. They have observed that he has been experiencing painful swelling in his fingers and toes over the past few days. They have also noticed that he has been excessively fatigued and that his skin and eyes appear to have a yellowish tint. The family recently relocated from Ghana but were unable to access prenatal or postnatal screening tests. The parents had plans to travel by plane for a pre-booked vacation in three days.
What is the safe duration for the family to travel, given the probable diagnosis for this infant?

MSFinals-1262

A 16-year-old girl has been admitted to the acute medical unit for a mild exacerbation of her asthma. She has recovered well, and her peak flow measurements have almost returned to normal. After being seen on the ward round, she asks an FY1 for contraceptive advice. She mentions that she is sexually active with one partner, her 19-year old boyfriend.
What is the first most appropriate action?

MSFinals-1263

You are the FY1 working on a pediatric ward. You overhear the nurses speaking about the son of one of your patients in a derogatory way. This upsets you as you have built a good rapport with the patient and his family.
Which of the following is the most appropriate action?