Archives: Medical Student Finals

MSFinals-0850

A 14-year-old boy is brought to the Emergency department by his parents. He has a two day history of general malaise, vomiting and vague abdominal discomfort. Over the past twelve hours he has become increasingly drowsy.

On examination, he was unresponsive to verbal commands. His temperature was 36.5°C and his blood pressure was 74/48 mmHg. The following investigations were done:

– Sodium: 121 mmol/L (137-144)
– Potassium: 6.2 mmol/L (3.5-4.9)
– Urea: 11.6 mmol/L (2.5-7.5)
– Creatinine: 162 µmol/L (60-110)
– Glucose: 1.1 mmol/L (3.0-6.0)
– Chloride: 91 mmol/L (95-107)
– Bicarbonate: 14 mmol/L (20-28)

After giving emergency treatment, what single investigation would be most valuable in confirming the diagnosis?

MSFinals-0851

A 35-year-old woman presents with sudden chest pain and difficulty breathing. She recently returned from a trip to Italy with her family. She has no significant medical history but takes oral contraceptives. On examination, her pulse is 100 bpm, temperature is 37°C, oxygen saturation is 95%, respiratory rate is 28/min, and blood pressure is 116/76 mmHg. Chest examination is unremarkable and chest x-ray is normal. What is the most appropriate diagnostic test to confirm the diagnosis?

MSFinals-0852

For which group is hepatitis B vaccination not typically recommended due to their low risk status?

MSFinals-0853

As a foundation year doctor, you have been requested by the resuscitation nurse to prescribe Tazocin in accordance with departmental policy for a 50-year-old patient with COPD who was previously seen by your colleague and is currently undergoing treatment for severe sepsis. However, ten minutes later, you receive a fast bleep to the resuscitation room where the patient is now experiencing hypotension, tachycardia, and developing a urticarial rash and wheezing. The patient’s medical records indicate that they have an allergy to penicillin. What is the next therapeutic measure you will prescribe?

MSFinals-0854

A 22-year-old individual is brought to the medical team on call due to fever, neck stiffness, and altered Glasgow coma scale. The medical team suspects acute bacterial meningitis.

What would be the most suitable antibiotic option for this patient?

MSFinals-0855

An 80-year-old woman presents to the Emergency department with a Pretibial laceration and skin flap after injuring her leg on furniture at home. She is currently taking prednisolone for polymyalgia rheumatica. What is the optimal approach to managing this injury?

MSFinals-0821

A 36-year-old patient presented to the general practitioner with a complaint of a pale, velvety, hypopigmented patch on his chest and shoulder that he has been experiencing for the past few months. He reports no pain, itching, or scaling on the lesion. The patient has a medical history of rheumatoid arthritis and is currently taking methotrexate. Upon examination, scraping revealed scaling.
What is the most probable diagnosis for this patient?

MSFinals-0822

A 7-year-old child has developed itchy, oozing sores on their body, palms, and soles. The child’s two siblings are also experiencing similar symptoms. What is the best course of treatment for this patient?

MSFinals-0823

A 28-year-old patient presents with a history of well demarcated, erythematous lesions with silvery-white scaling plaques on the extensor surfaces of the elbows. There is evidence of nail pitting.
What is the most appropriate management?

MSFinals-0824

An 85-year-old man who lives alone visits his General Practitioner complaining of a worsening itchy, red rash over his trunk, arms and legs. He has a medical history of psoriasis, hypertension and high cholesterol. Upon examination, the doctor observes an extensive erythematosus rash with scaling covering a large portion of his body. The patient has a normal temperature, a blood pressure of 110/88 mmHg and a heart rate of 101 bpm. What is the most appropriate course of action for this patient, considering the probable diagnosis?