Archives: Medical Student Finals

MSFinals-0060

An 83-year-old man is brought to the Emergency Department after being discovered in an acute state of confusion. He was lethargic and combative, attempting to strike his caregiver when she visited his home earlier that day. He has a history of chronic obstructive pulmonary disease (COPD) and continues to smoke 20 cigarettes per day, and is currently undergoing testing for prostatism. Upon examination, he has a fever of 38.2 °C and exhibits coarse crackles and wheezing in both lungs upon auscultation.

Investigations:
Investigation Result Normal value
Haemoglobin 121 g/l 135–175 g/l
White cell count (WCC) 14.2 × 109/l 4–11 × 109/l
Platelets 231 × 109/l 150–400 × 109/l
Sodium (Na+) 128 mmol/l 135–145 mmol/l
Potassium (K+) 4.4 mmol/l 3.5–5.0 mmol/l
Creatinine 120 μmol/l 50–120 µmol/l
Urine Blood +

What is the most probable diagnosis?

MSFinals-0061

A 65-year-old woman presents to the Emergency Department with severe bilateral pneumonia, which is found to be secondary to Legionella. She is hypoxic and drowsy and has an acute kidney injury. She is intubated and ventilated and transferred to the Intensive Care Unit. Despite optimal organ support, her respiratory system continues to deteriorate, requiring high fraction of inspired oxygen (FiO2) (0.8) to maintain oxygen saturations of 88–92%. A chest X-ray shows diffuse bilateral infiltrates. A diagnosis of acute respiratory distress syndrome (ARDS) is made.
Which of the following is a recognised component of the management strategy for ARDS?

MSFinals-0062

A 31-year-old man presents to the Emergency Department, appearing ill at 2300 after consuming ‘a few handfuls’ of paracetamol tablets. Upon further inquiry, it is revealed that this occurred at approximately 1400 and the patient weighs 80 kgs.
What is the initial step that should be taken?

MSFinals-0063

A 28 year old patient is brought in by ambulance to the emergency department. He is a known intravenous drug user and is currently presenting with mild respiratory depression, reduced level of consciousness, and pinpoint pupils. What would be the most appropriate medication for initial management?

MSFinals-0064

A 32-year-old patient is brought in by ambulance to Accident and Emergency. He is unresponsive, and therefore obtaining a medical history is not possible. He is breathing on his own, but his respiratory rate (RR) is low at 10 breaths per minute and his oxygen saturation is at 90% on room air. His arterial blood gas (ABG) reveals respiratory acidosis, and his pupils are constricted.
What would be the most suitable medication for initial management in this case?

MSFinals-0065

A 20-year-old woman arrives at the Emergency Department in Nepal. She had flown from the United Kingdom the previous day for a hiking trip with her friends. She reports feeling light-headed and dizzy in the hotel lobby in the morning. Despite taking a short rest, she continues to feel unwell and complains of nausea and a generalised dull headache. She is overweight and has no history of migraine. Although she is well oriented, she feels that her nausea and headache are getting worse.
What would be the most appropriate course of action for managing this patient?

MSFinals-0066

A 17-year-old girl is brought to the Emergency Department via ambulance with reduced level of consciousness, non-blanching rash, headache, neck stiffness and fever. Her mother accompanies her and states that this confusion started several hours previously. She also states that her daughter has not passed urine since the previous day, at least 16 hours ago. On clinical examination, she appears unwell and confused, and she has a purpuric rash over her lower limbs. Her observation results are as follows:
Temperature 39.5 °C
Blood pressure 82/50 mmHg
Heart rate 120 bpm
Respiratory rate 20 breaths per minute
Which of the following are high-risk criteria when diagnosing and risk-stratifying suspected sepsis?

MSFinals-0067

A 65-year-old man, with a history of hypertension and atrial fibrillation being treated with warfarin, experiences a catastrophic intracranial hemorrhage. Despite receiving the highest level of organ support in the ICU, he fails to show any signs of improvement. Before deciding to withdraw organ support, he is evaluated for brain death.
What healthcare professionals are necessary to diagnose brain death?

MSFinals-0068

A 65-year-old patient presents with acute severe abdominal pain and the following blood results:
Investigation Result Normal value
Haemoglobin 130 g/l
Female: 115–155 g/l
Male: 135–175 g/l
White cell count (WCC) 18 × 109/l 4–11 × 109/l
Sodium (Na+) 142 mmol/l 135–145 mmol/l
Potassium (K+) 4.2 mmol/l 3.5–5.0 mmol/l
Urea 22 mmol/l 2.5–6.5 mmol/l
Creatinine 95 μmol/l 50–120 μmol/l
Calcium 1.9 mmol/l 2.20–2.60 mmol/l
Lactate Dehydrogenase (LDH) 800 IU/l 50–120 IU/l
Albumin 30 g/l 35–50 g/l
Amylase 1600 U/l < 200 U/l
What is the most appropriate transfer location for ongoing care?

MSFinals-0069

A 30-year-old previously healthy man is involved in an accident at home. He is brought to Accident and Emergency where he is found to have superficial abrasions to the right side of his chest and upper abdomen, together with an obvious deformity of the right humerus. Radiograph of the right arm shows a displaced midshaft humerus fracture. Neurovascular examination reveals radial nerve palsy, together with absent peripheral pulses and a cool, clammy distal arm. He was given oral paracetamol at home, while waiting for the ambulance to arrive. Pain score remains 9/10. Parameters are as follows:
Investigation Result Normal value
Temperature 36.9 °C 36.1–37.2 °C
Pulse 110 bpm 60–100 bpm
Blood pressure 140/90 mmHg < 120/80 mmHg
Oxygen saturations 98% on room air 94–98%
Respiratory rate 22 breaths/min 12–18 breaths/min
Which of the following is the most appropriate form of pain relief?