Archives: Medical Student Finals

MSFinals-0385

A 21-year-old unemployed woman attempts suicide by ingesting a household substance in excess. Her arterial blood gas analysis shows the following results:
pH 7.26 (normal range: 7.35–7.45)
pCO2 3.0 kPa (normal range: 4.6–6.0 kPa)
pO2 14.6 kPa (normal range: 10.5–13.5 kPa)
HCO3- 15.2 mmol/l (normal range: 24–30 mmol/l)
BE -7.4
Sodium (Na+) 142 mmol/l (normal range: 135–145 mmol/l)
Potassium (K+) 4.3 mmol/l (normal range: 3.5–5.0 mmol/l)
Chloride (Cl-) 103 mmol/l (normal range: 98-106 mmol/l)
Urea 12.9 mmol/l (normal range: 2.5–6.5 mmol/l)

What is the anion gap of the 21-year-old patient?

MSFinals-0386

A 33-year-old known insulin-dependent diabetic presents to the Emergency Department, feeling generally unwell and complaining of diarrhoea and vomiting. Their observations are within the normal range, and on examination they look pale and dehydrated.
A venous blood gas is performed which shows the following: pH 7.13, HCO3− 14, base excess −8.0. The result of the urea and electrolytes blood test are as follows: Na+ 140, K+ 4.0, Cl− 97, urea 4.5, creatinine 67.
What is the patient’s anion gap?

MSFinals-0387

A 67-year-old man presents to the emergency room unconscious with a long history of polyuria and polydipsia. Investigations reveal elevated levels of sodium, potassium, urea, and glucose. What is the osmolality?

MSFinals-0388

A 21-year-old with long-standing type 1 diabetes mellitus is brought unconscious to the Emergency Department. Investigations reveal:
Investigation Result Normal value
Sodium (Na+) 160 mmol/l 135–145 mmol/l
Potassium (K+) 6.0 mmol/l 3.5–5.0 mmol/l
Urea 50 mmol/l 2.5–6.5 mmol/l
Glucose 60 mmol/l 3.5–5.5 mmol/l
PO2 15 kPa 10.5–13.5 kPa
pH 7.1 7.35–7.45
pCO2 1.3 kPa 4.6–6.0 kPa
Chloride (Cl−) 90 mmol/l 98-106 mmol/l
Bicarbonate 4.0 mmol/l 24–30 mmol/l
What is the anion gap?

MSFinals-0389

A patient’s arterial blood gas shows the following:
pH 7.30
O2 13 kPa
CO2 3.0 kPa
HCO3− 15.0 mmol/l
Which of the following does the above blood gas picture represent for a patient in their 60s?

MSFinals-0348

A radiologist examining a routine chest X-ray in a 50-year-old man is taken aback by the presence of calcification of a valve orifice located at the upper left sternum at the level of the third costal cartilage.
Which valve is most likely affected?

MSFinals-0349

A first-year medical student is participating in a bedside teaching session and is instructed to listen to the patient’s heart. The student places the stethoscope over the patient’s fourth left intercostal space just lateral to the sternum.
What heart valve’s normal sounds would be best detected with the stethoscope positioned as described?

MSFinals-0350

A 50-year-old male smoker presents with a 6-hour history of gradual-onset central chest pain. The chest pain is worse on inspiration and relieved by leaning forward. He reports recently suffering a fever which he attributed to a viral illness. He has no significant past medical history; however, both his parents suffered from ischaemic heart disease in their early 60s. An electrocardiogram (ECG) reveals PR depression and concave ST-segment elevation in most leads. He is haemodynamically stable.
What is the most appropriate management?

MSFinals-0351

A 55-year-old woman arrives at the emergency department with a two hour history of central crushing chest pain. She has a history of ischaemic heart disease and poorly controlled diabetes. The ECG shows ST-elevation in V1, V2 and V3, and her serum troponin levels are elevated. What is the most suitable definitive management approach?

MSFinals-0352

A 28-year-old man presents with chest pain, 5/10 in intensity, which is aggravated by breathing deeply and improved by leaning forward. The chest pain is not radiating. He has a mild fever but denies nausea, vomiting, cough or haemoptysis. He has self-medicated for a common cold and sore throat 5 days previously. On the electrocardiogram (ECG), there is diffuse, mild ST segment elevation (on leads II, aVF and V2–V6) and PR depression.
Which of the following findings is most likely to be observed on physical examination?