Archives: Medical Student Finals

MSFinals-1264

A patient, a retired teacher, attends your dermatology clinic in Scotland. She asks if her friend can sit in the room whilst the consultation takes place. During the consultation, you note that she is unable to retain some information, does not remember her phone number, and repeats several things in a way that makes it seem she does not remember that she has already told you. She lives on her own, has driven her car to the appointment and, whilst in the appointment, answers her mobile phone in a confident manner. You feel that her dermatological condition would benefit from phototherapy.
Can the patient consent to this?

MSFinals-1265

Based on the most recent guidance regarding cosmetic surgery from the General Medical Council, (GMC), which of the following statements is true if we consider the latest age criteria?

MSFinals-1266

A 25-year-old woman in hospital with terminal cancer has suddenly deteriorated over the last week. She can no longer communicate her decisions with regard to her health care. She had previously made an advanced decision that stated she did not want to be put on a ventilator.
In which one of the following scenarios would the advanced decision be considered valid?

MSFinals-1235

A 26-year-old man has been brought to the Psychiatric Ward by his family members who are concerned about his mental health. They believe he needs to be admitted to the hospital to be formally assessed by Psychiatry. He has been detained under the Mental Health Act (MHA), as he would not agree to be admitted voluntarily. The situation is not an emergency.
What is the appropriate duration for the Section to be valid when admitting this patient under the MHA for assessment?

MSFinals-1236

An 85-year-old woman visits her GP with her daughter to discuss advance care planning. She has a history of a stroke three years ago with dense hemiplegia, ischaemic heart disease and COPD on home oxygen. She has had several recent hospital admissions for exacerbations. She has a very limited quality of life and desires to be managed palliatively at home for future exacerbations.
What is required to establish the legal validity of an advance directive?

MSFinals-1237

A 15-year-old Scottish resident presents to your Scottish Emergency Department with a 10-hour history of acute right-sided abdominal pain. On examination, she has acute appendicitis. She is keen to proceed with the recommended surgery. You are unable to contact a parent or any other contact given by the patient.
What do you need in order to proceed?

MSFinals-1238

A 57-year-old man is admitted to the Intensive Care Unit (ICU) with a severe exacerbation of COPD. Despite full intervention, being intubated and ventilated, he fails to respond to treatment and continues to steadily deteriorate. It is believed that the patient is now brain dead.
The patient is unconscious, fails to respond to outside stimulation and it is believed that his heart rate and breathing are only being maintained by the ventilator. The patient has agreed in the past to be an organ donor, and brainstem death verification is sought. The consultant with six years’ experience is present to certify brainstem death; however, a further person is needed for the process.
Which of the following people is most appropriate to certify brainstem death along with the consultant?

MSFinals-1239

You visit a 50-year-old woman with motor neurone disease at home in England. She has become unwell over the last 48 h and, after assessing her, you conclude that she has aspiration pneumonia. Without admission to hospital for intravenous antibiotics, there is a high probability that she will die. At the time you assess her, she is exhibiting signs of delirium and is unable to retain or weigh the information needed to make decisions about her medical care. Her family indicates that she has repeatedly said that she does not want admission to hospital for treatment under any circumstances and would like to die at home. There is also a record of these wishes, as stated to her general practitioner, in her primary care records.
Select the most appropriate course of action.

MSFinals-1240

An 82-year-old man has presented with a productive cough, green sputum, a temperature of 39.5°C, heart rate 110 beats per minute and a blood pressure of 95/60 mmHg. He has been given oxygen and started on intravenous antibiotics for community-acquired pneumonia but despite full care he has not been responding to treatment. He is currently unresponsive.
The patient has a background of lung adenocarcinoma and is receiving chemotherapy. His wife says that he has had enough of his treatment, particularly as it has not been effective, and on his last admission he said he did not wish to have cardiopulmonary resuscitation (CPR), and this was recorded in the notes.
What is the best option regarding a do not resuscitate order for this patient?

MSFinals-1241

A 30-year-old is admitted to A&E with seizures. He is advised not to drive. You spot him in the parking lot of a nearby grocery store, having just parked the car he was driving. He has an upcoming clinic appointment in a week.
What is the most suitable course of action?