Master Specialist Forensic Medicine (FRM5161)
for DHA Speciality

A 34-year-old man is brought to the emergency department 6 hours after a witnessed generalized tonic-clonic seizure. He is drowsy but rousable, with a Glasgow Coma Scale score of 13 (E3 V4 M6). His pupils are equal and reactive, and there is no focal neurological deficit. He has a known history of epilepsy and takes sodium valproate. His blood ethanol concentration is 280 mg/dL (60.8 mmol/L). A non-contrast CT scan of the brain is reported as normal. Which is the most appropriate next step in management?

A 28-year-old woman at 32 weeks' gestation is brought to the emergency department after a road traffic collision. She is haemodynamically stable with a blood pressure of 118/72 mmHg and a heart rate of 92 beats/min. She has no abdominal pain or vaginal bleeding. Focused assessment with sonography for trauma (FAST) is negative. The obstetric team requests a CT scan of the abdomen and pelvis to exclude occult injury. Which is the most appropriate action?

A 62-year-old man with a history of hypertension and type 2 diabetes is found unresponsive at home. On arrival, his blood pressure is 210/110 mmHg, heart rate 88 beats/min, and oxygen saturation 96% on room air. He has a Glasgow Coma Scale score of 6 (E1 V1 M4). His pupils are pinpoint and symmetric. A non-contrast CT of the brain shows a small pontine haemorrhage. His family reports he was prescribed a new medication 3 days ago for neuropathic pain. Which is the most likely culprit?

A 45-year-old woman is brought to the emergency department after ingesting 30 tablets of paracetamol 500 mg (15 g) 4 hours ago. She weighs 70 kg. She has a history of anorexia nervosa with a body mass index of 16 kg/m2. Her serum paracetamol concentration at 4 hours is 120 mg/L (0.79 mmol/L). Her liver function tests are normal. Which is the most appropriate management?

A 70-year-old man is admitted with a fractured neck of femur after a fall. He is scheduled for surgery. His medications include warfarin for atrial fibrillation. His INR on admission is 4.8. The anaesthetist asks for your advice on reversing the anticoagulation before surgery. Which is the most appropriate agent?