A 35-year-old refugee is admitted to the hospital with complaints of persistent cough and significant weight loss. Further tests reveal that the patient has multidrug-resistant tuberculosis (MDR-TB). What is the most appropriate measure to prevent the spread of infection?
A 35-year-old man was admitted following a motorcycle accident that caused significant soft tissue damage to his right lower leg. He had previously been in good health and fitness. Five days after admission, he reported experiencing thoracic back pain. Upon examination, his temperature was 37.8 °C and he was tender over the T8 vertebra. Diagnostic tests revealed a normal X-ray of the entire spine and an MRI of the entire spine (T2) that showed high signal in the disc space and adjacent endplates, indicating bone marrow edema and likely discitis. Which organism is most likely responsible for his back pain?
A 54-year-old woman with a history of rheumatoid arthritis treated with methotrexate and etanercept presents to the Emergency Department for assessment. Her husband has recently been diagnosed with influenza and is taking paracetamol and ibuprofen for symptoms. On examination, her vital signs are stable and her chest is clear. What is the appropriate plan for influenza prophylaxis?
A 32-year-old woman presents to the Emergency Department with the most severe headache she has ever experienced, accompanied by a high fever of 39.8 oC. She complains of excruciating muscle and joint pain, describing it as if her bones were being crushed. She has also vomited multiple times. She recently returned from a trip to the Amazon rainforest. Her blood pressure is 100/70 mmHg, and her pulse is 110 bpm. She has a widespread maculopapular rash.
The following investigations were conducted:
s
Haemoglobin (Hb) 130 g/l 120 – 160 g/l
White cell count (WCC) 4.8 × 109/l 4.0 – 11.0 × 109/l
Platelets (PLT) 95 × 109/l 150 – 400 × 109/l
Sodium (Na+) 142 mmol/l 135 – 145 mmol/l
Potassium (K+) 4.2 mmol/l 3.5 – 5.0 mmol/l
Creatinine (Cr) 136 µmol/l 50 – 120 µmol/l
Aspartate aminotransferase (AST) 380 iu/l 0 – 37 iu/l
Which type of insect is most likely responsible for transmitting her infection?
A 26-year-old woman presents to her GP with a complaint of fever and a macular rash that started yesterday. She is currently eight weeks pregnant and has not received the rubella vaccine. The GP orders blood tests which reveal a negative rubella IgM and a rubella HAI titre of 1:64. What advice should be given to the patient?
A 25-year-old male of Indian origin presents with fever, cough, and weight loss. He recently returned to the United Kingdom after spending three months in India where he developed these symptoms. He is diagnosed with pulmonary tuberculosis and started on rifampicin, isoniazid, and pyrazinamide. After four weeks, he returns with fever, myalgia, and lethargy. His lab results show abnormal renal function. Which of the following is the most probable cause of his renal impairment?
Haemoglobin 145 g/L (130-180)
WBC 7.5 ×109/L (4-11)
Neutrophils 5.5 ×109/L (1.5-7)
Lymphocytes 0.8 ×109/L (1.5-4)
Monocytes 0.05 ×109/L (0-0.8)
Eosinophils 1.14 ×109/L (0.04-0.4)
Basophils 0.01 x 109/L (0-0.1)
Platelets 350 ×109/L (150-400)
Serum sodium 141 mmol/L (137-144)
Serum potassium 5.1 mmol/L (3.5-4.9)
Serum urea 27.9 mmol/L (2.5-7.5)
Serum creatinine 400 µmol/L (60-110)
Serum bilirubin 7 µmol/L (1-22)
Serum aspartate transaminase 31 U/L (1-31)
Serum alkaline phosphatase 97 U/L (45-105)
Serum albumin 39 g/L (37-49)
Urinalysis Protein +
Leucocytes +
No bacteria
Urine culture Negative
A 30-year-old woman with a history of IV drug use is admitted with fever, arthralgia, and a rash. She has been deteriorating over the past six weeks and admits to using injection sites around her groin and feet. On examination, she has a soft systolic murmur at the lower left sternal edge. Her blood pressure is 110/70 mmHg, pulse is 85/min and regular, and her temperature is 37.8 °C. Investigations reveal abnormal results including focal segmental proliferative glomerulonephritis on renal biopsy. Which of the following is an appropriate next investigation?
A 35-year-old woman presented with a 3-day history of severe headache and neck stiffness. She also had a 5-day history of non-bloody diarrhea.
On examination, her temperature was 38.2 °C, blood pressure was 130/76 mmHg and pulse rate was 92 beats/min. She had meningism and moderate photophobia. There were no neurological signs.
Investigations:
Random plasma glucose 5.8 mmol/l 3.9 – 7.1 mmol/l
CT head Normal
Lumbar puncture:
Opening pressure 20 mmHg 10 – 20 cmHg
Appearance Clear fluid
Appearance No organisms seen
Cell count 90 cells/mm3 (lymphocytes)
Cerebrospinal fluid (CSF) protein 0.9 g/dl 0.15 g/dl
Cerebrospinal fluid (CSF) glucose 4.1 mmol/l 3.3 – 4.4 mmol/l
What is the most important further investigation?
A 49-year-old Asian man undergoes a Mantoux test during his immigration screening upon arrival in the United Kingdom. The test comes back positive, but his chest X-ray appears normal, and he is prescribed isoniazid and pyridoxine (vitamin B6). However, he returns to the hospital four weeks later complaining of fever, abdominal pain, and jaundice. What is the probable cause of his symptoms?
A 35-year-old woman with a history of chronic alcohol abuse, type 2 diabetes, and latent tuberculosis presents to the Emergency Department with complaints of tingling in her feet for the past four weeks. She is currently taking metformin and isoniazid monotherapy for her conditions. On examination, she appears unkempt and smells strongly of alcohol. Neurological examination reveals absent ankle reflexes and diminished sensation in her lower limbs. Her blood work shows normal glucose levels, but low levels of serum B12 and folate. What is the best treatment for her condition?