Archives: Medical Student Finals

MSFinals-6060

A 55-year-old man with a history of diabetes is three days post-open umbilical hernia repair. He is experiencing mild central abdominal pain and feeling generally unwell. Upon examination of the wound, the area surrounding it appears red and inflamed with localized tenderness. Although there is pus coming from the wound, there is no separation of the incision.
Vital signs:
Blood pressure 130/70 mmHg
Heart rate 110 bpm
Respiratory rate 18 breaths per minute
Oxygen saturation 98% on room air
Temperature 38.2 °C
What is the most appropriate immediate management for this patient given the likely diagnosis?

MSFinals-6061

A patient is having an emergency laparotomy for a likely sigmoid perforation secondary to diverticular disease. She is 84, has known ischaemic heart disease under medical management, and was in new atrial fibrillation (AF) pre-operatively. You find that she has two quadrant peritonitis and despite fluid resuscitation her blood pressure is becoming low. You start Noradrenaline. She is going to intensive care unit (ICU) postoperatively.
Which scoring system is generally used in this context to predict outcome?

MSFinals-6062

A 5-year-old boy is scheduled for surgery to remove a sebaceous cyst on his neck. During examination, a sebaceous cystic swelling measuring 2 cm in diameter is found in the left anterior neck triangle near the midline, with a punctum on top. The surgeon makes an elliptical incision around the cyst and removes the skin with the central punctum. The cyst is then removed to a depth of 1 cm. You have been tasked with closing the skin wound. What is the best option?

MSFinals-6063

A patient in their 60s with severe intermittent claudication undergoes an axillo-bifemoral bypass. Two days after the operation, they develop pain in the leg. Examination reveals a warm, erythaematous swelling in the groin.
What complication has occurred?

MSFinals-6065

A 45-year-old man has been experiencing left shoulder pain for the last five years. Recently, this pain has become more severe, and he has been advised to undergo a left shoulder replacement surgery. The patient has a history of diabetes and high blood pressure, but no other medical conditions. During his preoperative evaluation, the patient inquires about eating and drinking before the surgery, as he will not be staying overnight and will be arriving at the hospital on the day of the procedure.
What is the appropriate information to provide to this patient regarding fasting times for elective surgery?

MSFinals-6066

What percentage of infants born with any level of hearing impairment are identified through neonatal screening as being at a high risk of having congenital hearing loss?

MSFinals-6067

A 65-year-old man is diagnosed with an infrarenal abdominal aortic aneurysm during an ultrasound scan for bladder outflow obstruction. What is the diameter of the aneurysm that warrants intervention in an asymptomatic patient?

MSFinals-6068

After catheterisation for acute urinary retention due to a lower urinary tract infection, what is the maximum acceptable residual urine volume in patients aged 65 years or older?

MSFinals-6069

A 23-year-old man is in a car accident and is diagnosed with a pelvic fracture. During his hospital stay, the nursing staff notifies you that he is experiencing lower abdominal discomfort. Upon examination, you discover a bloated and sensitive bladder. What is the optimal course of action?

MSFinals-6070

A 24-year-old male victim of an acid attack has been brought to the resus department. He has sustained burns on approximately 25% of his body surface area and weighs 60kg. The medical team needs to determine the amount of fluid resuscitation required for the next 24 hours using the Parkland formula based on his weight and the extent of burns. What is the volume of fluid resuscitation that should be administered to this patient over the next 24 hours?