Archives: Medical Student Finals

MSFinals-0080

A 30-year-old man is brought by ambulance, having fallen off his motorbike. He was wearing a helmet at the time of the crash; the helmet cracked on impact. At presentation, he is haemodynamically stable and examination is unremarkable, aside from superficial abrasions on the arms and legs. Specifically, he is neurologically intact. He is nevertheless offered admission for head injury charting and observation. Two hours after admission, nurses find him unresponsive, with a unilateral fixed, dilated pupil. An emergency computed tomography (CT) scan is performed.
What is the likely diagnosis in this case?

MSFinals-0081

A 65-year-old woman presents to Accident and Emergency with chest pain.
For which of the following is a chest X-ray the least appropriate as an investigation to best manage the patient?

MSFinals-0082

A 5-year-old boy is brought to the Emergency Department with symptoms of lethargy, high fever, and headache. During examination, he presents with neck stiffness and a rash. When should the communicable disease consultant (CDC) be notified?

MSFinals-0083

You see a 92-year-old gentleman who has been admitted following a fall. He had been discovered lying on the floor of his home by a neighbour. He has a diagnosis of dementia and cannot recall how long ago he had fallen. His observations are normal and he is apyrexial. A pelvic X-ray, including both hips, shows no evidence of bony injury. A full blood count is normal.
His biochemistry results are as follows:
Investigation Result Normal value
Creatinine 210 μmol/l 50–120 µmol/l
Urea 22.0 mmol/l 2.5–6.5 mmol/l
Sodium 133 mmol/l 135–145 mmol/l
Potassium 4.9 mmol/l 3.5–5.0 mmol/l
C-reactive protein (CRP) 8 mg/l 0–10 mg/l
What is the most appropriate investigation to request next?

MSFinals-0084

A 49-year-old man with severe acute pancreatitis is transferred from the surgical ward to the Intensive Care Unit with rapidly worsening shortness of breath. He has a history of heavy smoking and alcohol use.
On examination, in the Intensive Care Unit, he is maintaining saturations of 91% only on the ‘non-rebreather’ mask. There is cyanosis around the lips; bilateral crackles are present on auscultation of the lungs.
Investigations:
Investigation Result Normal value
pH 7.32 7.35–7.45
pO2 8.1 kPa (on oxygen) 10.5–13.5 kPa
pCO2 4.8 kPa 4.6–6.0 kPa
Chest X-ray Bilateral pulmonary infiltrates
Which of the following is the most likely diagnosis in this case?

MSFinals-0085

A 55-year-old man is admitted to the Intensive Care Unit (ICU) after acute haemorrhagic pancreatitis. On day 3, he develops acute respiratory distress syndrome (ARDS).
Which of the following physiological variables is most likely to be low in this patient?

MSFinals-0086

You have watched the anaesthetist anaesthetise a 70-year-old patient for a laparoscopic appendicectomy using thiopentone and suxamethonium. She has never had an anaesthetic before. The patient is transferred from the anaesthetic room into theatre and you notice that she becomes difficult to ventilate with high airway pressures. She has an endotracheal tube (ETT) in situ, with equal chest rise and sats of 95% on 15 l of oxygen. On examining her cardiovascular system, she has a heart rate of 110 bpm with a blood pressure of 68/45 mmHg. She has an erythematosus rash across her chest and face.
What is your first line of action?

MSFinals-0087

A 68-year-old man was recently admitted to hospital with small bowel obstruction. A nasogastric (NG) tube was inserted, and he has been prescribed intravenous (IV) fluids. Three days later, he reports feeling short of breath, and on examination, he has widespread fine crackles and pitting sacral oedema. His notes show that he has been receiving 2 litres of fluid a day and that he weighs 50 kg. You treat him, and once his symptoms have resolved, you’re-calculate his daily maintenance fluid requirements.
Which of the following options is the most suitable amount of daily fluid to give to the patient?

MSFinals-0088

You are due to transfer a critically unwell patient from theatre to intensive care. The oxygen cylinder is size D (contains 340 l of oxygen when full) and has been running for 12 minutes. The oxygen is running at 10 l/min.
How long do you have to transfer the patient before the oxygen cylinder is empty?

MSFinals-0089

A 60kg woman with a functional residual capacity (FRC) of 2.5 l is pre-oxygenated adequately for 3 minutes. Oxygen extraction per minute is 250 ml.
How long will the patient have in theory before they begin to desaturate?