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 35-year-old homeless, intravenous drug user is brought to the emergency department by his concerned companions. The patient is having difficulty speaking clearly and has been experiencing progressive weakness, particularly in his face, along with difficulty swallowing and some double vision.
During the examination, the patient displays a broad gait and flaccid weakness throughout his body. Cranial nerve examination reveals ptosis, ocular and facial muscle weakness. However, the patient’s GCS is normal, and the rest of his exam is unremarkable.
Upon further inquiry, the group accompanying the patient reports that another one of their friends was admitted to the hospital with similar symptoms a few days ago. The hospital’s computer system reveals that this friend’s blood cultures grew a gram-positive, anaerobic bacillus.
What urgent care should be provided to the patient?
A 42-year-old man presents to the emergency department with sudden confusion. His wife reports that he had been experiencing nausea and vomiting for the past 10 days since returning from a trip to Vietnam. He has no significant medical history and takes no regular medications. His brother was treated for tuberculosis 6 months ago.
The patient’s vital signs are as follows:
Temperature 38.3ºC
Heart rate 116 beats/min
Blood pressure 112/76 mmHg
Respiratory rate 16 breaths/min
Saturations 96% on air
On examination, he is disoriented to time and place but recognizes his wife. He complains of a severe headache, but the rest of his neurological exam is unremarkable. His chest is clear, heart sounds are normal, and his abdomen is soft and non-tender.
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 39 year-old intravenous drug user presented to the emergency department with severe watery diarrhoea and abdominal cramps lasting for 12 days. She had a history of treatment for a groin abscess 2 years ago. The patient denied any recent travel or consumption of contaminated food. She smoked 15 cigarettes per day and consumed 30-40 units of alcohol per week.
Upon examination, her vital signs were stable except for a heart rate of 102 beats per minute and a blood pressure of 90/60 mmHg. The tongue appeared dry with white patches on the hard palate and throat. The JVP was not visible, and there was mild central abdominal tenderness.
Laboratory investigations revealed a haemoglobin level of 168 g/L, white cell count of 4.2 * 109/l, neutrophil count of 2.8 * 109/l, lymphocyte count of 0.1 * 109/l, eosinophil count of 0.3 * 109/l, and platelets of 420 * 109/l. The patient’s electrolyte levels were within normal limits, but her creatinine level was elevated at 115 mol/L, and her albumin level was low at 28 g/L.
An abdominal x-ray showed no abnormalities, and a stool culture did not yield any growth after 48 hours. What additional staining technique should be used to analyze the stool sample?
A 43-year-old immigrant from Nigeria has been sent to the infectious disease clinic due to feeling fatigued and unwell for several weeks since returning from Nigeria, his country of origin. He also traveled to the United States for business six months ago. The patient has experienced fever, rigors, and headaches, and has posterior lymph nodes that were aspirated one week ago, revealing the presence of trypomastigotes. What is the probable organism responsible for this condition?
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?