Archives: Medical Student Finals

MSFinals-0899

A 57-year-old male presents with acute abdominal pain that has worsened over the past two hours. The pain originates in the epigastric region and radiates to the left side of his back, with colicky characteristics. He has vomited three to four times, with the vomit being greenish in color.

Upon examination, his temperature is 37.5°C, pulse is 100 beats per minute, and blood pressure is 114/80 mmHg. He has guarding of the abdomen and marked tenderness in the epigastrium. Bowel sounds are infrequent but audible.

Lab results show a neutrophilic leukocytosis, elevated glucose and urea levels, and an elevated creatinine level. Urinalysis reveals an elevated amylase level. Abdominal x-ray shows no abnormalities.

What is the likely diagnosis?

MSFinals-0900

A 23-year-old gardener experiences a sudden onset of breathlessness and right-sided chest pain while tending to the plants. He is quickly taken to the hospital, but his condition deteriorates during the examination conducted by a junior doctor.

The doctor notes a deviated trachea to the left and very faint breath sounds over the right lung. However, with the assistance of a senior doctor, the patient’s condition improves rapidly.

What is the likely diagnosis for this patient?

MSFinals-0874

A 65-year-old patient has just been administered intravenous ceftazidime. Suddenly, the patient experiences flushing and wheezing, and their blood pressure drops to 80/40 mmHg. What is the most suitable immediate action to take for this patient?

MSFinals-0875

A 56-year-old woman who underwent Hartmann’s procedure six hours ago has started to complain of abdominal pain and light-headedness. On assessment, she has a blood pressure of 80/40 mmHg, a heart rate of 120 bpm, a respiratory rate of 22 breaths per minute, oxygen saturations of 98% and a temperature of 36.7 °C. She appears drowsy and pale, and the radial pulse is difficult to detect. Her abdomen appears rigid and is painful to palpate, and a bleed is suspected.
What type of shock is this patient most likely to have?

MSFinals-0876

A 65-year-old man experiences a bout of memory loss. He had a moment of confusion three days prior, during which his wife guided him inside and offered him tea. Despite being conscious and able to converse with his wife, he wandered around the house in a confused state and repeatedly asked the same questions. After three hours, he suddenly returned to his normal state and had no memory of the incident. What is the probable diagnosis?

MSFinals-0877

According to the Glasgow coma scale (GCS), what does a verbal score of 1 indicate?

MSFinals-0878

Which of the following indicates a verbal response score of 1 on the Glasgow Coma Scale?

MSFinals-0879

A 16-year-old boy is brought to the Emergency department by his parents. He has no past medical history of note.

In his parents’ absence, he reveals that he took an overdose of paracetamol after a fight with his girlfriend, but did not intend to end his life.

What is the most reliable indicator of the extent of liver damage?

MSFinals-0880

You are requested by the medical registrar to assess a 65-year-old man who has been admitted to the hospital with fevers, pleuritic chest pain, and a productive cough. The emergency department has initiated initial management, but the registrar wants you to ensure that all the necessary investigations recommended by the surviving sepsis guidelines have been requested. The patient’s vital signs are HR 110 regular, BP 80/50 mmHg, O2 90% room air. Currently, a complete blood count, blood cultures, renal and liver function tests have been ordered, and intravenous fluids have been started. What other investigation is required according to the sepsis guidelines?

MSFinals-0881

You are the medical SHO in A and E. A 25-year-old female is admitted in a distressed state and experiencing shortness of breath. She is finding it difficult to speak in complete sentences and is breathing rapidly. Upon examination, her respiratory rate is 35 breaths per minute, pulse rate is 120 beats per minute, blood pressure is 110/70 mmHg, oxygen saturation is 90%, and her peak expiratory flow rate is less than 50% of predicted. The emergency medical services have administered salbutamol 5 mg twice and provided face mask oxygen. An ABG test is pending. What is the most appropriate next step for this patient?