Sarah is a 65-year-old woman with hepatocellular carcinoma, currently admitted to a hospice for end of life care. She is experiencing nausea without vomiting and would like something to help alleviate this.
During examination, she appears jaundiced and there is a significant amount of ascites present. She is feeling bloated and has not had a bowel movement in 3 days, but is passing gas.
What medication would be the most appropriate to address her nausea?
A 56-year-old woman presents to the clinic for evaluation. She has been experiencing bloody, serous discharge from her left nostril for the past three weeks and reports that her nose feels constantly congested. The patient has a 30-year history of smoking 20 cigarettes per day and a medical history of COPD. On examination, her blood pressure is 132/72 mmHg, pulse is regular at 85 beats per minute, and she is unable to breathe through her left nostril. Laboratory results show a hemoglobin level of 120 g/L (normal range 115-160), white blood cell count of 7.0 ×109/L (normal range 4.5-10), and platelet count of 199 ×109/L (normal range 150-450). Her sodium level is 138 mmol/L (normal range 135-145), potassium level is 4.5 mmol/L (normal range 3.5-5.5), and creatinine level is 105 µmol/L (normal range 70-110). An electrocardiogram reveals sinus rhythm. What is the most appropriate course of action?
A 55-year-old man who gave up smoking ten years ago presents at surgery with hoarseness.
It has been present for four weeks and is not improving. He has no systemic illness to explain it and the only thing of note is that he is a heavy whisky drinker.
You suspect he may have laryngeal cancer.
Which of the following symptoms would augment that suspicion?
A 27-year-old female comes to the clinic with a nodule in her neck that she has noticed for the past month.
Upon examination, a non-tender, 3.5 cm nodule is found on the right side of her neck, deep to the lower half of the right sternocleidomastoid. The nodule moves upwards on swallowing, and no other masses are palpable in the neck.
What is the nature of this mass?
A 42-year-old man presents with a ‘neck lump’ that he has noticed over the past two months. On examination, you palpate a diffuse midline swelling which moves with swallowing but not with tongue protrusion. There are no other neck lumps or focal nodules, and the patient’s voice is normal with no hoarseness. There is no cervical lymphadenopathy or stridor. The patient has no significant past medical history or family history.
He reports feeling slightly more fatigued and has gained some weight over the past few months but otherwise feels well. He notes that the swelling in his neck has not changed in size since he first noticed it.
Thyroid function tests reveal hypothyroidism. What is the most appropriate management plan?
You are reviewing a patient who presented to a colleague about eight weeks ago. He is a 65-year-old male with mild to moderate symptoms of nasal congestion and persistent feeling of a blocked nose. He reports ongoing problems of a similar nature. He informs you that as well as the above he gets intermittent clear nasal discharge which can alternate between nostrils and he has had periods of nasal and ocular ‘itch’.
At his last appointment he was prescribed a daily non-sedating antihistamine which he has been using regularly. He was also given advice on nasal douching. Despite these measures he is still suffering from persistent nasal symptoms. He has heard that steroid medication can be used to treat his symptoms and asks for a prescription.
Which of the following is the most appropriate next pharmacological option to add in to his treatment in trying to manage his symptoms?
A 50-year-old woman comes in with complaints of hearing loss. Tuning fork tests are performed, revealing a Rinne-positive result on both sides (air conduction heard better than bone conduction) and lateralisation of the Weber test to the left ear. How should these tuning fork test results be interpreted?
A 25-year-old woman comes in with complaints of hearing loss. She appears to be in good health and there are no noticeable abnormalities during otoscopy. Tuning fork tests are conducted, revealing a negative Rinne test on the right side (bone conduction is better than air conduction) and a positive Rinne test on the left side. The Weber test shows lateralisation to the right ear. How should these tuning fork test results be interpreted?
What is a true statement about tuning fork tests used for hearing?
A 20-year-old, previously healthy, female presents with a nine day history of fever, sore throat and fatigue.
On examination of her throat, there are palatal petechiae and white tonsillar exudates. Two days ago, another doctor prescribed amoxicillin, and she has since developed a widespread maculopapular rash.
What is the diagnosis?