A 35-year-old mother with a 2-week-old infant comes to the Emergency Department for evaluation. She has developed mastitis in her right breast, and you are contemplating suitable antibiotic choices for her. What antibiotics would be safe to administer to the mother as she intends to continue breastfeeding?
A 32-year-old woman with a history of rheumatoid arthritis (RA) comes to the clinic for review. She is currently taking methotrexate and has quiescent disease, but is interested in starting a family.
On examination, there is no evidence of active joint inflammation, and her ESR is 13 mm/1st h. Liver function tests are normal.
What is the best course of action for managing her RA?
You diagnose a 32-year-old woman with rheumatoid arthritis (RA). She has a 3-year-old daughter and expresses her desire to have another child. Her arthritis is highly active, and treatment needs to be initiated. Based on current recommendations, which of the following medications would be the most suitable option?
A 30-year-old woman presents to the Emergency department some 90 mins after taking 40x300mg aspirin tablets. She feels nauseated, has vomited once, complains of severe tinnitus, and is hyperventilating. She has no past medical history of note and takes no regular medications. Examination reveals a blood pressure of 110/75 mmHg, pulse is 85 beats per minute and regular. Chest is clear, respiratory rate is elevated at 30/min. She has been given activated charcoal on admission. 1 litre of normal saline given intravenously over 1hr is in progress.
investigations
Hb 120 g/l
Platelets 195 * 109/l
WBC 9.8 * 109/l
Na+ 142 mmol/l
K+ 3.2 mmol/l
Urea 5.8 mmol/l
Creatinine 85 µmol/l
pH 7.52
Serum salicylate 4.5 mmol/l
What is the most appropriate next step in managing this patient?
A 21-year-old female presents to the hospital with a decreased level of consciousness. Her mother discovered her lying on the floor of her bedroom. The patient has a medical history of hypothyroidism, anxiety, and depression. Upon examination, her heart rate is 110 beats per minute, blood pressure is 124/80 mmHg, and respiratory rate is 36 breaths per minute.
The following blood results were obtained:
– Hemoglobin (Hb): 122 g/l
– Platelets: 488 * 109/l
– White blood cells (WBC): 14.2 * 109/l
– Neutrophils (Neuts): 11.8 * 109/l
– Lymphocytes (Lymphs): 1.8 * 109/l
– Sodium (Na+): 134 mmol/l
– Potassium (K+): 5.6 mmol/l
– Urea: 10.8 mmol/l
– Creatinine: 158 µmol/l
– C-reactive protein (CRP): 42 mg/l
– Chloride: 105 mmol/l
An arterial blood gas analysis revealed:
– PaO2: 10.1 kPa
– PCO2: 2.2 kPa
– pH: 7.28
– HCO3: 12 mmol/l
What is the most probable diagnosis?
A 28-year-old woman presents to the Emergency department with symptoms of a possible overdose. She appears confused, agitated, and sweaty, with reactive pupils measuring 4 mm in diameter. Her vital signs include a respiratory rate of 20 breaths per minute, pulse rate of 90 beats per minute, and blood pressure of 135/80 mmHg. Arterial blood gas results while breathing air show a pH of 7.52, PaCO2 of 2.8 kPa, PaO2 of 14 kPa, HCO3 of 17 mmol/L, and anion gap of -12. Her ECG is normal. What substance is she most likely to have ingested?
A 25-year-old female presents to the Emergency department with significant shortness of breath and tinnitus. She has a medical history of asthma and depression and is currently taking amitriptyline and salbutamol. Upon examination, she appears agitated with a pulse rate of 110 beats per minute, blood pressure of 102/40 mmHg, temperature of 37.7°C, and respiratory rate of 28 breaths per minute. An arterial blood gas reveals a pH of 7.48, pO2 of 11.2 kPa, pCO2 of 1.9 kPa, and bicarbonate of 13 mmol/L. What is the probable diagnosis?
A 30-year-old woman presented to the local emergency general practitioner while on vacation in Isle of Wight. She complained of increasing urinary frequency, lower abdominal pain, and dysuria, and was diagnosed with a urinary tract infection. She was prescribed a course of trimethoprim.
Three days later, she suddenly felt unwell with a headache and nausea while eating fish at a restaurant. She had no known allergies but had a history of well-controlled asthma, treated with a salbutamol inhaler on an as-needed basis.
Upon arrival at the Emergency department, she appeared flushed with a sinus tachycardia of 110 beats per minute, confirmed with a 12-lead electrocardiogram. Her temperature was normal, but her blood pressure was 90 mmHg systolic and 60 mmHg diastolic.
Auscultation of her chest revealed a widespread expiratory wheeze with a peak expiratory flow rate of 200 L/min. A widespread diffuse macular rash was also noted over her trunk and limbs.
What is the most likely diagnosis?
A 63-year-old woman presents to the gastroenterology clinic with a history of watery diarrhoea for the past 6 months, with 4-6 bowel movements per day. She has a medical history of hypertension, ischaemic heart disease, Type 2 diabetes, and depression.
Lab results show Hb 11.5 g/l, Na+ 139 mmol/l, Bilirubin 12 µmol/l, Platelets 207 * 109/l, K+ 3.9 mmol/l, ALP 95 u/l, WBC 8.9 * 109/l, Urea 7.2 mmol/l, ALT 23 u/l, Neuts 5.6 * 109/l, Creatinine 100 µmol/l, γGT 56 u/l, Lymphs 1.8 * 109/l, Albumin 38 g/l, and Eosin 0.5 * 109/l.
During colonoscopy, mild mucosal oedema is observed, and biopsy reveals lymphocytic infiltration. Which of the following agents is most likely responsible for her colonoscopy findings?
A 56-year-old man is admitted to the acute medical unit with confusion and abnormal movements. He has a medical history of bipolar disorder and epilepsy and is currently taking lithium and sodium valproate. On examination, choreathetoid movements are observed in all four limbs, and his Glasgow coma score is 11 (M5, E3, V3).
The following blood results are obtained:
– Hb: 145 g/l
– Platelets: 524 * 109/l
– WBC: 11.6 * 109/l
– Neuts: 9.8 * 109/l
– Na+: 138 mmol/l
– K+: 3.9 mmol/l
– Urea: 10.5 mmol/l
– Creatinine: 125 µmol/l
– Lithium level: 2.6 mmol/L (therapeutic range 0.4 to 1.0 mmol/L)
What is the definitive treatment required for this patient?