Barbara is a 44 year old woman with a diagnosis of metastatic ovarian cancer. She is a single mother of 3 children: John who is 14 years old, Michael who is 17 years old preparing for his A-Levels, and Sarah who is 20 years old and attending college. She seeks your guidance on child tax credits. Which of her children qualify for child tax credits?
A 2-year-old boy presents having had a seizure. His sister hit him; he became still and very pale, stiffened and fell to the floor. He was unresponsive for 20 seconds, with his eyes rolled up and with jerking of all four limbs. He did not wet himself or bite his tongue. He has no previous history and seems well now.
What is the most likely diagnosis?
A 9-month-old baby presents with a brief history of cough and difficulty breathing. During the examination, the infant has a temperature of 38.6°C and a respiratory rate of 37. The baby appears distressed, and there are widespread crackles and wheezing sounds when listening to the chest. The pulse rate is 170 BPM. What is the most probable diagnosis?
A 14-year-old boy presents with acute left testicular pain. He is not sexually active.
On examination the scrotum appears normal but he has a tender, swollen left testis. The right testis appears normal.
Urine dip is negative.
What is the most likely diagnosis?
A 55-year-old man presents after experiencing a panic attack at work. He reports feeling extremely hot and unable to concentrate, with a sensation of the world closing in on him. Although his symptoms have mostly subsided, he seeks medical attention. Upon examination, his pulse is 78 beats per minute, blood pressure is 188/112 mmHg, and respiratory rate is 14 breaths per minute. Fundoscopy reveals small retinal hemorrhages, but cardiovascular examination is otherwise unremarkable. The patient’s PHQ-9 score is 15 out of 27. What is the most appropriate course of action?
Mary comes to see you for a medication review. She is a 65-year-old woman, with a past medical history of chronic kidney disease stage 3, hypertension and gout. Her current medication are amlodipine 10 mg daily and allopurinol 100 mg daily. Her blood pressure today is 151/93 mmHg. A recent urine dip was normal and her blood results are shown in the table below.
Na+ 137 mmol/L (135 – 145)
K+ 4.7 mmol/L (3.5 – 5.0)
Bicarbonate 27 mmol/L (22 – 29)
Urea 5.6 mmol/L (2.0 – 7.0)
Creatinine 130 µmol/L (55 – 120)
eGFR 55 ml/min/1.73m2 (>90)
What changes should you make to her medications?
You are examining the results of an ambulatory blood pressure monitor (ABPM) for a 65-year-old man with suspected hypertension. You have also arranged an ECG, blood tests and a urine dipstick, all of which have been normal. According to QRISK, his 10-year cardiovascular risk is 7%. The ABPM results reveal an average daytime reading of 148/94 mmHg. What is the best course of action?
A 63-year-old man presents with a three-month history of palpitation. He reports feeling his heart skip a beat regularly but denies any other symptoms such as dizziness, shortness of breath, chest pain, or fainting.
Upon examination, his chest is clear and his oxygen saturation is 98%. Heart sounds are normal and there is no peripheral edema. His blood pressure is 126/64 mmHg and his ECG shows an irregularly irregular rhythm with no P waves and a heart rate of 82/min.
What is the most appropriate next step in managing this patient?
A 48-year-old man presents to the hypertension clinic with a recent diagnosis of high blood pressure. He has been on ramipril for three months, but despite titration up to 10 mg od, his blood pressure remains elevated at 156/92 mmHg.
What would be the most suitable course of action for further management?
You are speaking with a 57-year-old man who is worried about his blood pressure control. He has been monitoring his blood pressure at home daily for the past week and consistently reads over 140/90 mmHg, with the highest reading being 154/86 mmHg. He has no chest symptoms and is otherwise healthy. He has a history of hypertension and is currently taking perindopril. He previously took amlodipine, but it was discontinued due to significant ankle edema. His recent blood test results are as follows:
Na+ 136 mmol/L (135 – 145)
K+ 4.6 mmol/L (3.5 – 5.0)
Bicarbonate 24 mmol/L (22 – 29)
Urea 5.1 mmol/L (2.0 – 7.0)
Creatinine 80 µmol/L (55 – 120)
What is the most appropriate next step in managing his hypertension?