A 29-year-old female presents to the emergency department with decreased consciousness. She has a medical history of depression, which is managed with sertraline, chronic pain treated with tramadol, gabapentin, ibuprofen, and a lidocaine patch, and epilepsy controlled with phenytoin.
During the examination, the patient’s Glasgow Coma Score is 11 (M4, V4, E3), and the physician observes mydriasis, hyperreflexia, and clonus.
Which medication is the most likely cause of these symptoms?
A 50-year-old, previously healthy construction worker presents to the hospital with difficulty breathing. He also reports experiencing nausea, vomiting, and diarrhea. During the physical exam, the patient displays widespread expiratory polyphonic wheezing and muscle fasciculations. His wife reports that he has been working on a construction site for the past two days. Upon examination, the patient’s pupils are constricted bilaterally, and his blood pressure is 95/50 mmHg with a heart rate of 38 bpm. Which medication is most likely to provide the greatest benefit?
A 75-year-old woman was seen at the outpatient clinic for review. She was diagnosed with polymyalgia rheumatica a year and a half ago after presenting with generalised myalgia and bilateral shoulder stiffness. Her ESR on presentation was 60 mm/1st hour (0-30). Treatment with prednisolone 15 mg daily, calcium, and vitamin D supplementation was initiated, and she responded well, with symptom resolution within a week. However, her symptoms have consistently relapsed whenever the prednisolone dose has been reduced below her current dose of 12.5 mg daily. What is the appropriate management for her condition?
A 49-year-old man is being treated for severe hypertension and left ventricular failure with intravenous sodium nitroprusside. His condition has improved with a BP of 145/80 mmHg and pulse of 75/min. However, a few hours later, he becomes acutely confused, short of breath, and complains of chest and abdominal pain with vomiting. On examination, his BP is now 100/60 mmHg with a pulse of 90/min. His investigations reveal a low haemoglobin level, high creatinine level, and widespread ST depression consistent with myocardial ischaemia. What is the most appropriate treatment for his suspected diagnosis?
A 59-year-old man, who has been on long-term amiodarone therapy, presents to the clinic with complaints of heat intolerance, anxiety, regular resting palpitations, and diarrhea. Upon examination, his blood pressure is 145/82 mmHg, and his resting pulse is elevated at 90/min. He has a multinodular goiter. Laboratory investigations reveal low hemoglobin levels, normal white cell count and platelets, high creatinine levels, and positive thyroid autoantibodies. His TSH levels are below normal, and his free T3 and T4 levels are high. An ultrasound confirms the presence of a multinodular goiter. The decision is made to discontinue his amiodarone therapy. What is the most appropriate treatment to control his thyrotoxicosis?
A 35-year-old man with a history of well-controlled allergies on loratadine goes out to a seafood restaurant with colleagues. While eating his main course he suddenly develops difficulty breathing, feels very dizzy and looks flushed in the face. An ambulance is called, which brings him to the Emergency Room. On examination he looks unwell with a BP of 90/60 mmHg, a pulse of 110/min and severe wheeze on auscultation of the chest. He has significant facial flushing and a rash over his neck resembling hives.
What is the most appropriate treatment for him?
You are summoned to attend to a 37-year-old woman in the Emergency Department. She was brought in by ambulance after her friend gave her a pill that was supposed to alleviate her symptoms following a night out and a recent cold.
Upon examination, she appears very ill. Her BP is 70/40 mmHg and her pulse is 104/min. She is perspiring and cold. She has stridor and significant wheezing upon chest auscultation. Additionally, there is a rash resembling urticaria. The emergency team has already initiated a 500 ml bag of normal saline.
What is the best initial course of action for her?
You are the first response doctor at a chemical factory fire where various types of polyurethane foams are manufactured. A 46-year-old man is rescued from the main part of the factory and complains of chest tightness and dizziness. Upon examination, you observe signs of pulmonary edema and quickly apply a tight-fitting facemask and high-flow oxygen. However, the patient’s condition worsens, and he experiences respiratory arrest. You intubate and ventilate him. What would be the most appropriate next step given the likely cause of his deterioration?
A 32-year-old homeless woman, a frequent visitor to the Emergency Department, is brought in by ambulance after experiencing a seizure on the street. Upon examination, she is unresponsive and in a post-ictal state. Her blood pressure is 100/70 mmHg, pulse is 80 and regular. A toxicology screen reveals methanol levels of 10.5 mmol/l, and she has a metabolic acidosis with a pH of 7.10 and bicarbonate levels of 8 mmol/l. A bag of N saline is started to run over 1 hour. What is the most crucial next step in her treatment?
A 24-year-old woman presents with sudden swelling of her lips, hands, and legs. She is concerned as she experienced similar symptoms last year and was hospitalized. Her father and uncle have also had similar episodes of facial swelling. On examination, there is significant swelling of the lower lip and a generally puffy face. The chest is clear, and she is not experiencing any breathing difficulties.
What is the recommended treatment for this patient’s symptoms?