Archives: Medical Student Finals

MSFinals-0002

A 71-year-old man attends the Emergency Department with a 3-day history of a warm, red, tender right lower leg. He thinks it is the result of banging his leg against a wooden stool at home. He has a past medical history of diabetes. He is unable to recall his drug history and is unsure of his allergies, although he recalls having ‘a serious reaction’ to an antibiotic as a child.
You diagnose cellulitis and prescribe an initial dose of flucloxacillin, which is shortly administered. Several minutes later, the nurse asks for an urgent review of the patient since the patient has become very anxious and has developed a hoarse voice. You attend the patient and note swelling of the tongue and lips. As you take the patient’s wrist to feel the rapid pulse, you also note cool fingers. A wheeze is audible on auscultation of the chest and patchy erythema is visible. You ask the nurse for observations and she informs you the respiratory rate is 29 and systolic blood pressure 90 mmHg. You treat the patient for an anaphylactic reaction, administering high-flow oxygen, intravenous (iv) fluid, adrenaline, hydrocortisone and chlorpheniramine.
What is the dose of adrenaline you would use?

MSFinals-0003

A 34-year-old surgical patient develops wheeze, lip swelling, and pallor while receiving antibiotics. Her blood pressure is 70/38 mmHg. What urgent treatment is required?

MSFinals-0004

A 35-year-old man is brought to the Emergency Department following a car accident. He has a head injury and has vomited twice within the ambulance. His eyes are open to voice; he is able to squeeze your hand with both hands, when asked, and wiggle his toes. He is confused about what has happened and does not remember the accident. He cannot remember his age and tells you that he does not know where he is currently. Other injuries include a broken collarbone (immobilized). His sats are 98% on 10 l high-flow oxygen, with a heart rate of 100 bpm and a blood pressure of 120/80 mmHg.
What is his Glasgow Coma Scale (GCS) score?

MSFinals-0005

A 7-year-old girl was brought to the Emergency Department by her parents. Her lips were swollen; she had stridor and was short of breath, and she was sweaty and clammy. She has a known allergy to shellfish and had eaten some seafood at a family gathering.
What is the appropriate course of action?

MSFinals-0006

An 82-year-old man is brought to the Emergency Department, having suffered from a fall in his home. He has bruising to his face and legs and a ‘dinner fork’ deformity of his left wrist. His pulse is 70 bpm, blood pressure (BP) 110/90 mmHg, temperature 37.2 °C and oxygen saturations 98%. His plan includes an occupational therapy and risk assessment for falls, with a view to modification of his home and lifestyle to prevent future recurrence.
Approximately what percentage of people aged over 80 suffer from falls?

MSFinals-0007

A 35-year-old man comes to the Emergency Department (ED) with a fever of 40 °C, vomiting and diarrhea, and is extremely restless. He has hyperthyroidism but is known to not take his medication regularly. The ED registrar suspects that he is experiencing a thyroid storm.
What is the most probable statement about a thyrotoxic crisis (thyroid storm)?

MSFinals-0008

A 35-year-old patient arrives by ambulance after developing breathing difficulties. She is otherwise healthy but had recently been prescribed amoxicillin by her doctor for a lower respiratory tract infection.
During examination, she is unable to speak and has harsh upper airway sounds on inspiration. She also has a noticeable rash. Her pulse is 160 bpm and her blood pressure is 80/40. Her oxygen saturation is 90% on high-flow oxygen.
What is the initial step in managing this patient?

MSFinals-0009

You are the on-call general practitioner and are called urgently to the nurses’ room where a 6-year-old boy receiving his school vaccinations has developed breathing difficulties. The child has swollen lips and is covered in a blotchy rash; respiratory rate is 40, heart rate is 140 and there is a wheeze audible without using a stethoscope.
After lying the patient flat and raising his legs, what immediate action is required?

MSFinals-0010

A 28-year-old man is brought to the Emergency Department after an episode of near-drowning. He fell from a boat into a lake and was unable to swim. He was underwater for < 2 minutes before he was rescued. He did not lose consciousness. He reports swallowing lots of water and vomited twice in the ambulance. He is awake and alert; his observations are as follows: blood pressure 126/76 mmHg, pulse 94 bpm, oxygen saturations 94% on room air, and temperature 36 °C. He is coughing occasionally, and his lungs are clear to auscultation. One hour after the episode, he feels well and wishes to go home.
What is the best management plan for this patient?

MSFinals-0011

A 42-year-old woman arrives at Accident and Emergency with severe cellulitis in her left lower limb. She has no known allergies, is in good health, and is not currently experiencing fever or rapid heart rate. The medical team accepts her and starts her on IV antibiotics. However, she soon becomes hypoxic, experiencing difficulty breathing, with loud upper airway sounds and a widespread rash.
What is the preferred treatment option in this scenario?