A 26-year-old male patient presents to the HIV clinic after testing positive on screening at a local GUM clinic. His CD4 count is 1020 cells/microlitre and viral load is 10,123 copies/ml. He has a history of depression and emigrated from Nigeria three years ago. He plans to return abroad in two years. Should he start antiretroviral treatment now or defer treatment, and what are the benefits of early treatment?
A 65-year-old man presented with a history of excessive urination, especially at night, which disturbs his sleep, excessive thirst, and tiredness for the past 2 months. He was a known HIV positive patient and has been on highly active anti-retroviral therapy (HAART) for the last 6 months. The physician suspected HIV-related diabetes mellitus. On clinical examination, everything was within normal limits. The following are his blood investigations:
Hb: 150 g/l
Platelets: 150 * 109/l
WBC: 7 * 109/l
Fasting blood glucose: 10 mmol/l
Postprandial blood glucose: 13.9 mmol/l
Serum creatinine: 130 umol/L
The physician planned to start him on metformin therapy. What investigation is important to check before starting metformin in this patient?
A 32-year-old man comes to the Emergency Department complaining of fevers, muscle pain, and a sore throat that have been going on for 3 days. He also reports feeling nauseous and having a decreased appetite. His 5-year-old son has been sick with similar symptoms. He has no medical history and only takes over-the-counter vitamins. He has no allergies.
During the examination, his temperature is 40.5 °C, heart rate is 135 bpm, and blood pressure is 100/70 mmHg. He has a dry cough and a runny nose. His chest sounds clear, and his oxygen saturation is 98% on room air. He has a red throat and swollen lymph nodes in his neck. The rest of his ear, nose, and throat exam is normal.
Throat swab: positive for influenza B
He is discharged with instructions to take pain medication and drink plenty of fluids. He is given a prescription for oseltamivir to take at home.
What is the mechanism of action of oseltamivir?
A 35-year-old IV drug user presents with fatigue, fever, and a new heart murmur. Upon examination, the doctor notes a temperature of 38.5 oC, blood pressure of 110/85 mmHg, and a pulse of 90 bpm with a pansystolic murmur. The patient has injection marks consistent with heroin use. Lab results show a low hemoglobin level of 100 g/l, a high white cell count of 14.2 × 109/l, and a high C-reactive protein level of 280 mg/l. A transthoracic echocardiogram reveals mitral regurgitation with valve vegetations. Blood cultures identify Bacillus cereus. What is the most appropriate antibiotic treatment?
A 33-year-old woman of African descent visits the HIV clinic. She has been under the care of the HIV service for the past 9 years since arriving in the UK. Currently, she is taking tenofovir, emtricitabine, and dolutegravir, and is highly compliant with her medication. She is feeling well despite experiencing some vomiting earlier in her pregnancy, as she is 17 weeks pregnant with her first child. She is excited about the pregnancy and has come to discuss her HIV management with you. Her blood tests reveal a CD4 count of 0.84×10^9/L, a CD8 count of 1.01×10^9/L, and a viral load of less than 20. What is the most appropriate course of action for this patient?
A 78-year-old man has been referred to the clinic with complaints of weight loss, right-sided chest pain, lower back pain, and general fatigue. He has no significant medical history. Upon examination, his Hb level is 96 g/L, platelet count is 399 * 109/L, and WBC count is 10.2 * 109/L. His urine Bence Jones test is positive. His electrolyte levels are within normal limits, but his creatinine level is elevated at 190 µmol/L. His calcium and phosphate levels are also elevated. What imaging modality should be used as the first-line investigation to confirm the most likely diagnosis?
A 57-year-old woman presents to her GP with vomiting and lethargy. Despite being generally healthy, she is experiencing concerning symptoms. Her GP orders blood tests and a urine sample to investigate further.
The results show that her hemoglobin levels are lower than normal, and her platelet and white blood cell counts are within the normal range. Her electrolyte levels are also abnormal, with low sodium and high potassium and urea and creatinine levels. Additionally, her calcium levels are high, while her phosphate and magnesium levels are within the normal range.
Further testing reveals the presence of Bence Jones protein in her urine electrophoresis. Given this finding, what imaging is recommended to assess for potential bony involvement?
A 29-year-old woman presents to the clinic with fatigue that has been progressively worsening over the past 4 weeks. She has a medical history of type 2 diabetes mellitus and regularly takes metformin and gliclazide. She also frequently binge drinks and consumes approximately 18 units of alcohol per week. All observations are within normal limits. Based on the following blood results, what is the most likely diagnosis?
Hb 92 g/L Male: (135-180)
Female: (115 – 160)
Platelets 75 * 109/L (150 – 400)
WBC 6.2 * 109/L (4.0 – 11.0)
Reticulocytes 225 109/L (50 – 100)
Urea 6.8 mmol/L (2.0 – 7.0)
Creatinine 65 µmol/L (55 – 120)
LDH 480 units/L (140 – 280)
Haptoglobins <0.5 g/L (0.5 - 2.2) Triglycerides 5.2 mmol/L (<2.3) Prothrombin time (PT) 12 secs (10-14 secs) Activated partial thromboplastin time (APTT) 32 secs (25-35 secs) Fibrinogen 2.4 g/L (2 – 4) D-Dimer 220 ng/mL (< 400) Bilirubin 28 µmol/L (3 – 17) ALP 580 u/L (30 – 100) ALT 36 u/L (3 – 40) γGT 860 u/L (8 – 60) Albumin 36 g/L (35 – 50) Direct antiglobulin test (DAT) Negative
A 28-year-old male presents with a high-grade fever and vomiting for 8 days. He recently returned from a jungle safari in Africa with a group of friends and began feeling unwell whilst he was there. During the trip, he spent most of the time camping outdoors. He does not have any history of fits or loss of consciousness, although he has been feeling drowsy and complains of generalised malaise. He also has pain in his ankle and knee joints but they are not swollen. He takes alcohol regularly and smokes cannabis socially.
On examination, he has a fever of 39°C and a pulse of 135 bpm. His blood pressure is 100/70 mmHg. He is icteric but does not have any flapping tremors. There is evidence of an enlarged spleen which is palpable 3 finger breadths below the left costal margin. The liver span is normal.
Lab reports reveal:
Hb 115 g/l
Platelets 100 * 109/l
WBC 9.5 * 109/l
Reticulocytes 5% (0.2 – 2%)
Na+ 140 mmol/l
K+ 4.6 mmol/l
Urea 5.1 mmol/l
Creatinine 83 µmol/l
Bilirubin 49 µmol/l
AST 50 u/l
ALT 25 u/l
Glucose 6.0 mmol/l
CT scan brain: Normal
CSF examination reveals:
Appearance Clear
Protein 0.3 g/L (0.2 0.4 g/L)
Glucose 5.3 mmol/l
Lymphocytes 15/mm³
Neutrophils 10
What is the most appropriate treatment option for this patient?
A 32 year-old HIV positive South African woman arrives at the emergency department complaining of fever and headache that have persisted for 12 days. During the examination, a 6th nerve palsy, papilloedema, and erythematous skin papules across her torso are observed. She is not taking any medication, and her CD4 count is 90 cells / mm³. A CT scan of her head is normal. What is the best immediate course of action?