Archives: Medical Student Finals

MSFinals-5869

A 67-year-old man is three days post-elective low anterior resection for colorectal cancer. He is being managed in the High Dependency Unit. He has developed a cough productive of green phlegm, increased wheeze and breathlessness on minor exertion. He has a background history of smoking. He also suffers from stage 3 chronic obstructive pulmonary disease (COPD) and is a known carbon dioxide retainer. On examination, he is alert; his respiratory rate (RR) is 22 breaths/minute, blood pressure (BP) 126/78 mmHg, pulse 110 bpm, and oxygen saturations 87% on room air. He has mild wheeze and right basal crackles on chest auscultation.
Which of the following initial oxygen treatment routines is most appropriate for this patient?

MSFinals-5876

A trauma call is initiated in the Emergency Department after a young cyclist is brought in following a road traffic collision. The cyclist was riding on a dual carriageway when a car collided with them side-on, causing them to land in the middle of the road with severe injuries, shortness of breath, and chest pain. A bystander called an ambulance which transported the young patient to the Emergency Department. The anaesthetist on the trauma team assesses the patient and diagnoses them with a tension pneumothorax. The anaesthetist then inserts a grey cannula into the patient’s second intercostal space in the mid-clavicular line. Within a few minutes, the patient expresses relief at being able to breathe more easily.

What signs would the anaesthetist have observed during the examination?

MSFinals-5878

A 40-year-old Afro-Caribbean man comes to the clinic complaining of fever, dry cough and joint pains. Upon examination, his chest is clear. He has several tender, warm, erythematous nodules on both shins. A chest X-ray reveals prominent hila bilaterally. What is the most probable diagnosis?

MSFinals-5862

A 36-year-old woman of African origin presented to the Emergency Department with sudden-onset dyspnoea. She was a known case of systemic lupus erythematosus (SLE), previously treated for nephropathy and presently on mycophenolate mofetil and hydroxychloroquine sulfate. She had no fever. On examination, her respiratory rate was 45 breaths per minute, with coarse crepitations in the right lung base. After admission, blood test results revealed:
Investigation Value Normal range
Haemoglobin 100g/l 115–155 g/l
Sodium (Na+) 136 mmol/l 135–145 mmol/l
Potassium (K+) 4.7 mmol/l 3.5–5.0 mmol/l
PaO2on room air 85 mmHg 95–100 mmHg
C-reactive protein (CRP) 6.6mg/l 0-10 mg/l
C3 level 41 mg/dl 83–180 mg/dl
Which of the following is most likely to be found in this patient as the cause for her dyspnoea?

MSFinals-5872

A 23-year-old man comes to the clinic complaining of sudden onset of difficulty breathing and sharp chest pain that worsens when he inhales. He has no significant medical history and is generally healthy and active. He admits to smoking and drinking occasionally. The patient is diagnosed with a pneumothorax caused by the spontaneous rupture of an apical bulla.
What is the most accurate description of the lung volume and chest wall position in this patient?

MSFinals-5863

A 68-year-old man with known bronchial carcinoma presents to hospital with confusion. A computed tomography (CT) scan of the brain was reported as normal: no evidence of metastases. His serum electrolytes were as follows:
Investigation Result Normal value
Sodium (Na+) 114 mmol/l 135–145 mmol/l
Potassium (K+) 3.9 mmol/l 3.5–5.0 mmol/l
Urea 5.2 mmol/l 2.5–6.5 mmol/l
Creatinine 82 μmol/l 50–120 µmol/l
Urinary sodium 54 mmol/l
Which of the subtype of bronchial carcinoma is he most likely to have been diagnosed with?

MSFinals-5881

A 63-year-old man presents to the Emergency department with worsening dyspnoea, dry cough, and low-grade fever. He has a medical history of hypertension and was hospitalized six months ago for an acute inferior myocardial infarction complicated by left ventricular failure and arrhythmia. His chest x-ray reveals diffuse interstitial pneumonia, and further investigations show an ESR of 110 mm/h, FEV1 of 90%, FVC of 70%, and KCO of 60%. What is the most likely cause of these findings?

MSFinals-5875

A 28-year-old woman presents to the Emergency Department (ED) with sudden onset of shortness of breath and chest pain. She also reports haemoptysis. An ECG shows no signs of ischaemia. Her heart rate is 88 bpm and blood pressure is 130/85 mmHg. The patient flew from Dubai to the UK yesterday. She has type I diabetes mellitus which is well managed. She had a tonsillectomy two years ago and her brother has asthma. She has been taking the combined oral contraceptive pill for six months and uses insulin for her diabetes but takes no other medications.
What is the most significant risk factor for the likely diagnosis?

MSFinals-5873

A 68-year-old woman presents to the Emergency Department with a 48-hour history of shortness of breath and an increased volume and purulence of sputum. She has a background history of chronic obstructive pulmonary disease (COPD), hypertension and ischaemic heart disease. Her observations show: heart rate (HR) 116 bpm, blood pressure (BP) 124/68 mmHg, respiratory rate (RR) 18 breaths per minute and oxygen saturation (SaO2) 94% on 2l/min via nasal cannulae. She is commenced on treatment for an infective exacerbation of COPD with nebulised bronchodilators, intravenous antibiotics, oral steroids and controlled oxygen therapy with a Venturi mask. After an hour of therapy, the patient is reassessed. Her observations after an hour are: BP 128/74 mmHg, HR 124 bpm, RR 20 breaths per minute and SaO2 93% on 24% O2 via a Venturi mask. Arterial blood gas sampling is performed:
Investigation Result Normal value
pH 7.28 7.35–7.45
PO2 8.6 kPa 10.5–13.5 kPa
pCO2 8.4 kPa 4.6–6.0 kPa
cHCO3- (P)C 32 mmol/l 24–30 mmol/l
Lactate 1.4 mmol/l 0.5–2.2 mmol/l
Sodium (Na+) 134 mmol/l 135–145 mmol/l
Potassium (K+) 3.8 mmol/l 3.5–5.0 mmol/l
Chloride (Cl-) 116 mmol/l 98-106 mmol/l
Glucose 5.4 mmol/l 3.5–5.5 mmol/l
Following this review and the arterial blood gas results, what is the most appropriate next step in this patient’s management?

MSFinals-5866

A 55-year old complains of difficulty breathing. A CT scan of the chest reveals the presence of an air-crescent sign. Which microorganism is commonly linked to this sign?