A 31-year-old man presents with a history of recurrent ulcers over several months. He reports experiencing oral ulcers regularly, with multiple occurring at a time, which typically resolve within a week. Additionally, he has been experiencing painless genital ulcers. He has recently attended the eye casualty department twice, where he was diagnosed with uveitis. On examination today, he has several oral ulcers and genital ulcers. What findings would support the probable diagnosis?
A 55-year-old man of Afro-Caribbean descent presents to the clinic with complaints of fever, joint pain, and lethargy. He has also noticed a rash on his arms and neck that comes and goes over the past six months. He has a medical history of congestive heart failure and chronic kidney disease due to hypertension. His current medications include bisoprolol, aspirin, and hydralazine/isosorbide dinitrate. On examination, there is no joint swelling, but he has patches of scaling on his neck and forearms. Laboratory tests reveal positive rheumatoid factor, anti-nuclear antibody, anti-single stranded DNA, and anti-histone antibodies, but negative anti-extractable nuclear antigen. What is the most likely diagnosis?
A 75-year-old male presents to the Emergency Department with a two-day history of right temporal, throbbing headache, constant in nature and 8/10 severity. He reports this being the first ever episode of this headache and is different to his previous migraines, which have been typically in the left occipital region, lasting minutes, and fairly stereotyped over the past 50 years. Apart from migraines, he has no other medical history.
On examination, his right scalp is tender and a prominent right temporal artery is noted. He is apyrexic with no skin rashes. His blood tests are as follows:
Hb 140 g/l
Platelets 550 * 109/l
WBC 11.0 * 109/l
ESR 80 mm/hr
Na+ 145 mmol/l
K+ 4.5 mmol/l
Urea 9.8 mmol/l
Creatinine 110 µmol/l
CRP 25 mg/l
You empirically start him on 60mg prednisolone. He undergoes temporal artery biopsy within 24 hours of his admission demonstrating no signs of temporal arteritis.
What is the most appropriate next step?
A 70-year-old male was recently prescribed alendronate for osteoporosis treatment after experiencing a fragility fracture. However, he presents to your clinic with concerning upper gastrointestinal adverse effects. What would be the most suitable course of action for his management?
A 67-year-old Caucasian female presents with a 3-week history of worsening headache and shortness of breath for the past 2 days. She reports difficulty sleeping at night due to her shortness of breath. She has no known medical or drug history. During examination, bilateral splinter hemorrhages are noted, with 4 on the right and 2 on the left, along with calcium deposits distally and black spots in the pulp of the fingers. Perioral skin puckering is also observed. Cardiovascular examination is unremarkable, while chest examination reveals bilateral coarse inspiratory crackles. Neurological examination is unremarkable, except for fundoscopy revealing papilledema, cotton wool spots, and flame hemorrhages. The patient is apyrexial, with Sats at 95% on 2 liters, respiratory rate at 24/min, blood pressure at 195/115 mmHg, HR at 90/min, and regular. Chest x-ray shows bilateral pleural effusion with bilateral alveolar shadowing. What is the most important immediate management?
A 65-year-old woman presents to the Emergency department with a one-week history of increasing breathlessness and coughing up small amounts of blood. She also reports frequent nosebleeds and headaches over the past two months, as well as feeling generally lethargic and losing weight. On examination, there are no signs of cyanosis, finger clubbing, pallor, or skin rash. The pulse is 100 beats/min and BP is 135/95 mmHg. Respiratory rate is 28 breaths/min, chest expansion is moderate, and inspiratory crackles are heard at the left lung base.
The following investigations were conducted: Hb 100 g/L (115-165), WCC 19.9 ×109/L (4-11), Platelets 540 ×109/L (150-400), Plasma sodium 139 mmol/L (137-144), Plasma potassium 5.3 mmol/L (3.5-4.9), Plasma urea 30.6 mmol/L (2.5-7.5), Plasma creatinine 760 µmol/L (60-110), Plasma glucose 5.8 mmol/L (3.0-6.0), Plasma bicarbonate 8 mmol/L (20-28), Plasma calcium 2.23 mmol/L (2.2-2.6), Plasma phosphate 1.7 mmol/L (0.8-1.4), Plasma albumin 33 g/L (37-49), Bilirubin 8 µmol/L (1-22), Plasma alkaline phosphatase 380 U/L (45-105), Plasma aspartate transaminase 65 U/L (5-35). Arterial blood gases on air reveal: pH 7.2 (7.36-7.44), pCO2 4.0 kPa (4.7-6.0), pO2 9.5 kPa (11.3-12.6). ECG shows sinus tachycardia and chest x-ray reveals a shadow in the left lower lobe. Urinalysis shows blood +++ and protein ++.
Which of the following would you expect to be positive in this patient?
A 67-year-old man presents to the Emergency department with increasing breathlessness and coughing up of small amounts of blood over the past two weeks. He also complains of frequent nosebleeds and headaches over the past three months. He feels generally lethargic and has lost a stone and a half in weight.
On examination, he has no cyanosis, finger clubbing, pallor or a skin rash. Pulse is 98 beats/min and BP 140/95 mmHg. Respiratory rate is 30 breaths/min, chest expansion moderate and on auscultation there are inspiratory crackles at the right lung base.
Investigations show:
Haemoglobin 95 g/L (115-165)
White cell count 20.5 ×109/L (4-11)
Platelets 550 ×109/L (150-400)
Plasma sodium 140 mmol/L (137-144)
Plasma potassium 5.5 mmol/L (3.5-4.9)
Plasma urea 32.1 mmol/L (2.5-7.5)
Plasma creatinine 780 µmol/L (60-110)
Plasma glucose 6.0 mmol/L (3.0-6.0)
Plasma bicarbonate 7 mmol/L (20-28)
Plasma calcium 2.25 mmol/L (2.2-2.6)
Plasma phosphate 1.8 mmol/L (0.8-1.4)
Plasma albumin 32 g/L (37-49)
Bilirubin 10 µmol/L (1-22)
Plasma alkaline phosphatase 400 U/L (45-105 >14 years)
Plasma aspartate transaminase 70 U/L (1-31)
Arterial blood gases on air:
pH 7.1 (7.36-7.44)
pCO2 3.8 kPa (4.7-6.0)
pO2 9.0 kPa (11.3-12.6)
ECG Sinus tachycardia
Chest x ray Shadow in right lower lobe
Urinalysis:
Blood +++
Protein ++
What is the most appropriate acid-base abnormality description for this patient?
A 65-year-old woman presents to the Emergency department with increasing breathlessness and coughing up of small amounts of blood over the past one week. She also complains of frequent nosebleeds and headaches over the past two months. She feels generally lethargic and has lost a stone in weight.
She is noted to have a purpuric rash over her feet. Chest expansion moderate and on auscultation there are inspiratory crackles at the left lung base.
Investigations show:
Haemoglobin 100 g/L (115-165)
White cell count 19.9 ×109/L (4-11)
Platelets 540 ×109/L (150-400)
Plasma sodium 139 mmol/L (137-144)
Plasma potassium 5.3 mmol/L (3.5-4.9)
Plasma urea 30.6 mmol/L (2.5-7.5)
Plasma creatinine 760 µmol/L (60-110)
Plasma glucose 5.8 mmol/L (3.0-6.0)
Plasma bicarbonate 8 mmol/L (20-28)
Plasma calcium 2.23 mmol/L (2.2-2.6)
Plasma phosphate 1.7 mmol/L (0.8-1.4)
Plasma albumin 33 g/L (37-49)
Bilirubin 8 µmol/L (1-22)
Plasma alkaline phosphatase 380 U/L (45-105)
Plasma aspartate transaminase 65 U/L (1-31)
Arterial blood gases on air:
pH 7.2 (7.36-7.44)
pCO2 4.0 kPa (4.7-6.0)
pO2 9.5 kPa (11.3-12.6)
ECG Sinus tachycardia
Chest x ray Shadow in left lower lobe
Urinalysis:
Blood +++
Protein ++
What is the most likely diagnosis?
A 65-year-old man presents with a one-week history of fever, chills, nausea, vomiting, and joint pain. He had been prescribed a five-day course of amoxicillin by his GP with no improvement. He reports experiencing use-related pain in his distal interphalangeal joints and knees, which is more severe than usual, and denies any cough, sore throat, or dysuria. His medical history includes diabetes mellitus, hypertension, coronary artery disease, and gout. On examination, he appears acutely unwell, with no rash noted. His temperature is 39.5°C, pulse 92 beats/min, and BP 180/95 mmHg. Investigations reveal a Hb of 105 g/L, WCC of 20.5 ×109/L, and a large effusion in his right knee. Apart from acute gout, what is the most likely diagnosis from the list below?
A 63-year-old man presents with a week of right-sided shoulder pain. He denies any trauma and denies radiation of the pain. There is no associated weakness or numbness. The pain is more noticeable at the extremities of movement and is affecting activities of daily living. His past medical history includes type 2 diabetes mellitus and asthma.
Upon examination, the affected shoulder is painful and restricted, with both active and passive movement. External rotation is most severely limited. Pain is elicited when applying direct pressure to the coracoid process.
What is the most appropriate next step given the most likely diagnosis?