A 26-year-old female came to the clinic complaining of dysuria and a recent onset of vaginal discharge. She has been engaging in unprotected sexual activity with a new male partner for the past six weeks. Her NAAT test showed positive results for Chlamydia and negative for gonorrhoeae infection. She is currently on her menstrual cycle.
What is the recommended initial treatment for this infection?
A 35-year-old woman presents to the Emergency department with weakness in both legs and a feeling of general malaise. She had recently returned from a four week trip to Eastern Europe. During examination, she appeared unwell and had a fever of 38.9°C. Large cervical lymph nodes were palpable on both sides of her neck, and her pharynx was inflamed with exudate on the pharyngeal wall. Neurological examination revealed global weakness in both legs and absent reflexes. What is the most likely diagnosis?
A 36-year-old Ghanaian man presents to the Emergency department after experiencing his first grand-mal seizure. He recently returned from a three-month holiday in Ghana where he was diagnosed with an ischaemic stroke due to right-sided weakness. He reports having low-grade fevers and a dry cough on and off for several months.
Upon examination, his GCS is 15/15, and his blood pressure is 110/65 mmHg. A neurological examination reveals mild right hemiparesis, but no meningism or papilloedema. A magnetic resonance scan of the brain shows several ring-enhancing lesions.
What is the most likely diagnosis?
A 35-year-old male refugee presents with fever, rigours and right flank pain. With the assistance of a translator, you discover that he has been feeling unwell for the past 7 days with symptoms that are progressively worsening. He claims to be otherwise healthy and not taking any regular medications. He moved to the UK 2 months ago after living his entire life in Sudan.
Upon examination, he has a temperature of 38.2 degrees, a heart rate of 98 beats per minute, a blood pressure of 110/70, and a respiratory rate of 20. He is lying calmly in bed but is tender over the renal angle on the right side.
Investigations reveal:
– Serum sodium 138 mmol/L (137-144)
– Serum potassium 5.5 mmol/L (3.5-4.9)
– Serum creatinine 240 mol/L (60-110)
– Haemoglobin 98 g/L (130-180)
– White cell count 15.4 × 109/L (4.0-11.0)
– Eosinophil count 0.89 × 109/L (0.04-0.40)
– Platelet count 378 × 109/L (150-400)
– Urine microscopy red cells 2+, white cells 3+, protein 2+
– Ultrasound scan of abdomen right-sided hydronephrosis and hydroureter, fibrotic and calcified bladder
What is the most probable underlying diagnosis?
You are requested to assess a patient on the ward who the nurse suspects is experiencing flushing. The nurse observed the change in the patient while administering their first dose of vancomycin. The patient is slightly older and has the following vital signs:
Temperature 37.2 ºc
Respiratory rate 18 breaths/min
Saturations on air 97%
Heart rate 70 beats/min
Blood Pressure 136/72 mmHg
The patient has a blanching macular rash on their upper arms and upper thighs, but no signs of urticaria or excoriations. There are no symptoms or signs of cardiorespiratory distress. The patient has a history of penicillin allergy.
What would be your next course of action?
A 50-year-old female presents with a rash. She reports feeling feverish and having a runny nose before the rash appeared on her arms, trunk, and legs. She recently moved to the UK from Poland, where she lived in a travellers community and has no knowledge of childhood vaccinations. She has a medical history of asthma and hereditary spherocytosis. On examination, an erythematous maculopapular rash is observed on her upper limbs, thorax, and lower limbs.
The following investigations were conducted:
Hb 95 g/l Na+ 138 mmol/l
Platelets 110 * 109/l K+ 3.8 mmol/l
WBC 3.8 * 109/l Urea 6.5 mmol/l
Neuts 1.8 * 109/l Creatinine 58 µmol/l
Lymphs 1.6 * 109/l CRP 48 mg/l
What is the most probable diagnosis?
Sarah is a 42-year-old female presenting with a new fever. She works as a teacher and noted fevers up to 39.6ºC over the past 72 hours with a dry cough. She has also been struggling to manage her classroom due to the ongoing headache and worsening muscle aches that have accompanied the fever. The headache was significant but was not associated with any neck stiffness or photophobia.
Sarah does not note any other symptoms. She has not been in contact with anyone unwell and she has not been travelling out of the country recently.
Physical examination was otherwise unremarkable with only mild crackles heard on auscultation on her chest. No insect bites were noted. No lymphadenopathy was palpable.
Blood tests are as follow:
Hb 140 g/L Male: (135-180)
Female: (115 – 160)
Platelets 150 * 109/L (150 – 400)
WBC 7.0 * 109/L (4.0 – 11.0)
Na+ 142 mmol/L (135 – 145)
K+ 4.1 mmol/L (3.5 – 5.0)
Urea 5.5 mmol/L (2.0 – 7.0)
Creatinine 100 µmol/L (55 – 120)
Bilirubin 10 µmol/L (3 – 17)
ALP 80 u/L (30 – 100)
ALT 90 u/L (3 – 40)
AST 80 u/L (5-40)
Albumin 40 g/L (35 – 50)
What is the likely organism causing the likely diagnosis?
A 28-year-old woman presents to the emergency department with drowsiness. She had been experiencing headaches, nausea, and fevers over the past day. About a week ago, she had a period of feeling unwell with fever, headache, and myalgia, but it resolved on its own. She recently returned from a camping trip in Poland with friends. Her medical history includes only asthma, which she manages with salbutamol as needed.
Upon examination, the patient has a Glasgow Coma Scale (GCS) of 14 with neck stiffness but no focal neurology. Her lungs are clear, and her abdomen is soft and non-tender. There is no rash.
After a lumbar puncture, mildly elevated white blood cells are found. An HIV test comes back negative. The patient is started on ceftriaxone, dexamethasone, and aciclovir.
Although the CSF culture and PCR are negative, a sample sent to the infectious disease laboratory comes back positive for flavivirus antibodies. What is the most appropriate management for this likely diagnosis?
A 16-year-old boy who has recently arrived in the UK from Rwanda is admitted to the hospital with complaints of headache and fever for the past four days. According to his friend, he is very lethargic with a dry cough and generalised myalgia. The patient also reports passing some dark urine this morning. He has no significant medical history. On examination, his pulse is 110/min, temperature 38.1ºC, oxygen saturations 98% on room air, and blood pressure 110/68 mmHg. His sclera are jaundiced, and there is enlargement of the liver and spleen. Blood tests reveal the following results:
Na+ 142 mmol/l
K+ 4.8 mmol/l
Urea 12.3 mmol/l
Creatinine 144 µmol/l
What is the most probable diagnosis?
A 50-year-old female presents with a two-month history of headache and generalised malaise. She describes her headaches as a tight band-like sensation that is present almost throughout the day and causes significant difficulty in sleeping at night. She also mentions occasional episodes of vomiting along with low-grade fever and weight loss of about 7 kg over the same duration of time. She suffers from generalised anxiety disorder and takes 0.5mg alprazolam TDS. She returned from Dubai 10 months ago where she had been spending her holidays with her family.
On examination, she has a fever of 37.5°C and a pulse of 105 bpm. She appears slightly disoriented with a tendency to speak out of context but is otherwise cooperative.
There is diplopia on right-sided gaze and mild neck stiffness, but the remaining clinical examination is essentially unremarkable.
Lab reports reveal:
Hb 115 g/l
Platelets 340 * 109/l
WBC 9.0 * 109/l
Na+ 137 mmol/l
K+ 4.2 mmol/l
Urea 5.9 mmol/l
Creatinine 102 µmol/l
Glucose 7.0 mmol/l
ESR 87 mm/hr
MRI shows meningeal enhancement but no evidence of any parenchymal lesions.
CSF examination reveals:
Opening Pressure Normal
Appearance Turbid
Protein 3.2g/L (0.2 0.4 g/L)
Glucose 2.7 mmol/l
Lymphocytes 371/mm³
Neutrophils 42/mm³
ZN staining No acid-fast bacilli detected
What is the most appropriate treatment option for this 50-year-old female?