Archives: Medical Student Finals

MSFinals-0012

A 32-year-old man presents to his General Practitioner (GP) with a lateral ankle injury. This injury occurred while playing basketball the previous day. He continued playing but noted some discomfort at the time and thereafter. He is able to weight-bear with minor discomfort. On examination, there is some swelling over the ankle, a small amount of bruising and minimal tenderness on palpation. There is full range of movement in the ankle joint. He has not taken any analgesia.
What is the best management of this man’s injury?

MSFinals-0013

Mrs Johnson is a 79-year-old lady who has been admitted with a urinary tract infection. She has a past medical history of chronic obstructive pulmonary disease (COPD), for which she takes inhalers. Her abbreviated mental test score (AMTS) was 8/10 on admission. A midstream urine sample was sent for microbiology and the report indicates a pure growth of Escherichia coli sensitive to trimethoprim and co-amoxiclav. After receiving 48 hours of intravenous co-amoxiclav, she is now on appropriate oral antibiotic therapy.
You are called to the ward at 0100 h as Mrs Johnson is increasingly agitated and confused. She now has an AMTS of 2/10 and is refusing to stay in bed. Her vital signs are normal, and respiratory, cardiovascular, abdominal and neurological examinations reveal some fine crepitations at both lung bases, but no other abnormality. Her Glasgow Coma Score (GCS) is 14.
What is the most appropriate next management option?

MSFinals-0014

An adolescent recovering from a first-time anaphylactic reaction to shellfish is being discharged.
What should be done at discharge?

MSFinals-0015

A 54-year-old woman presents to her General Practitioner (GP) with a 1-week history of productive cough and fever. She has had no sick contacts or foreign travel. She has a background history of mild intermittent asthma and is a non-smoker. She has been taking paracetamol and salbutamol. On clinical examination, her respiratory rate is 16 breaths per minute, oxygen saturations 96% (on room air), blood pressure 136/82 mmHg and temperature 38.2 °C. On chest auscultation, there is mild expiratory wheeze and coarse crackles in the right lung base.
What is the most appropriate management of this woman?