A 32-year-old woman develops chest pain after an argument with her 16-year-old daughter.
She is brought to the surgery where you are asked to see her. She is hyperventilating and looks very anxious. She is tender to light pressure on the front of her chest, but examination is otherwise unremarkable. Breathing room air, her oxygen saturation (finger probe) is 99%. Her ECG is normal.
What is the most appropriate course of action for this woman?
For which of the following should an urgent referral to the urology services be made?
You see a 65-year-old patient in your emergency clinic who takes Beclomethasone diproprionate 100 mcg/Formetorol fumarate 6 mcg two puffs twice daily for his asthma. He also uses salbutamol as and when required but says he has been needing two puffs four times a day for the past few days. Over the past two weeks he has been coughing thick green phlegm and feels more wheezy and says he is a lot shorter of breath than usual. He has been feeling feverish intermittently.
His symptoms are not getting better despite increasing his salbutamol. On examination, his temperature is 38.1 and his oxygen saturations are 92% in air. His chest sounds wheezy and he has crackles to the right basal region. His peak flow is 300 L/min (predicted of 610 L/min). His respiration rate is 24/minute and his pulse is 110 per minute. His blood pressure is 120/59.
What would be the most appropriate treatment option for this patient?
A 30-year-old man presented after several days of high fever and headache, which began to resolve. He presents now with jaundice on returning from a holiday in Spain.
As part of a group of 20 he had visited hillside forests and went fishing in mountain streams.
Which of the following organisms is most likely to be responsible for his illness?
A 10-year-old boy comes to you with a purpuric rash and symptoms and signs that strongly indicate Meningococcal meningitis. He has no known allergies.
What immediate steps should you take?
A 15-year-old boy with cystic fibrosis presents with abdominal pain. There is no associated nausea and vomiting. Which of the following is most likely to be the cause?
A 75-year-old man takes 2 x co-dydramol 10/500 tablets, four times daily for arthritis of his knee. During a routine medicines review over the phone, he reveals that he’s been buying paracetamol from the local supermarket for the past 2 months and supplements his co-dydramol with an additional paracetamol tablet four times a day.
You inform him that his prescribed medication contains paracetamol and that he’s effectively taking 3 x 500mg paracetamol tablets four times a day. A total of 12 tablets a day. He weighs 70Kg.
What is the threshold amount of paracetamol taken over a 24 hour period that would be required for medical admission and n-acetylcysteine infusion?
A 25-year-old medical student comes to you in January complaining of flu-like symptoms. She has been experiencing an on-and-off fever for the past few weeks, but no other physical symptoms are present. Interestingly, she completed an elective period in India nine months ago. What is the most likely cause of her illness?
A 12-year-old girl is brought to see you during an out-of-hours shift.
She has a past history of asthma and usually takes salbutamol 100 mcg 2 puffs as required and beclomethasone 100 mcg twice a day. Her usual peak flow is 280. She has been on her current inhalers for over a year with no problems or flare-ups.Over the last two days she has become increasingly wheezy and this seems to have been triggered by an upper respiratory tract infection.
On examination, she has a temperature of 37.5℃, and has a widespread polyphonic wheeze on auscultation of the chest. Her peak flow rate is measured at 190. Oxygen saturations are 97% in air. There is no respiratory distress.
She receives six puffs of salbutamol via a spacer and following this feels much better, with a PEFR of 260. The child is monitored in the department for a further hour and remains stable with her chest sounding clear.
What is the most appropriate management plan?
A 22-year-old female presents with shortness of breath. She is known to suffer from asthma and her usual best PEFR is 410 L/min.
Which of the following features would suggest that this is a severe asthma attack?