A 60-year-old patient has been diagnosed with chronic hepatitis B through blood tests. The doctor explains that the patient is highly contagious and at a greater risk of long-term disease. Which of the following blood results is most likely to be seen in this patient?
HbSAg Anti-HBs IgM anti-HBc IgG anti-HBc HBeAg Anti-HBe
A + – + + + –
B – + – + – +
C + – – + + –
D + – – + – +
E – + – – – –
A 27-year-old female is found in a confused and drowsy state. Her friend discovered her this morning after a night of drinking, but also mentions that she was upset about her recent breakup. Upon examination, she has a Glasgow coma scale rating of 10/15, a blood pressure of 138/90 mmHg, a temperature of 37.5°C, large pupils that react slowly to light, a pulse of 120 beats per minute, a respiratory rate of 32/min, and exaggerated reflexes with Downgoing plantar responses. Additionally, a palpable bladder is found during abdominal examination. What substance is she most likely to have taken?
A 20-year old woman arrives at the Emergency department after a night out with her friends. According to her friends, she has been talking to herself about nonsensical things and appears agitated and restless. During the examination, it is noted that her reflexes are heightened and an electrocardiogram (ECG) reveals ventricular ectopics. What type of substance abuse is suspected in this case?
A 75-year-old man is referred following a collapse at home. He is currently taking diclofenac for persistent low back pain. Upon examination, he appears pale and has a pulse of 110 beats per minute. His blood pressure is 110/74 mmHg while sitting and drops to 85/40 mmHg when standing. What is the most appropriate next step?
A 50-year-old male with a history of paroxysmal atrial fibrillation is experiencing uncontrolled tachycardia despite treatment with digoxin and bisoprolol, leading to acute left ventricular dysfunction. The patient has been prescribed amiodarone. What investigation must be done before starting amiodarone?
A 15-year-old girl comes to the clinic with bilateral cervical lymphadenopathy. Upon conducting a lymph node biopsy, it is revealed that she has nodular sclerosing Hodgkin’s disease. What characteristic is indicative of a worse prognosis for this patient?
A 35-year-old male presents to the emergency department with a 72 hour history of lethargy, fever, and a sore throat. The nurse reports that his breathing is harsh and high pitched. His vital signs show a temperature of 39.4°C and an elevated respiratory and heart rate. What is the probable diagnosis?
A 75-year-old man, with metastatic prostate cancer presented with a week’s history of severe weakness, obtundation, and poor oral intake.
One month ago, CT of the head revealed multiple intracerebral lesions. He underwent cranial irradiation and received dexamethasone, 12 mg orally daily.
On examination he is unwell and disoriented. Temperature is 36.6°C, pulse is 100/min, respiratory rate is 28/min and blood pressure is 110/60 mmHg supine. Chest examination and heart examination are normal. There is lower abdominal tenderness, especially in the suprapubic area. Diffuse muscle weakness is noted. No lateralizing neurologic signs or abnormal reflexes are noted.
Investigations reveal:
White cell count 19.5 ×109/L (4-11)
Plasma glucose 40 mmol/L (3.0-6.0)
Urea 25 mmol/L (2.5-7.5)
Creatinine 160 µmol/L (60-110)
Calcium 2.2 mmol/L (2.2-2.6)
Sodium 130 mmol/L (137-144)
Potassium 5.0 mmol/L (3.5-4.9)
Bicarbonate 24 mmol/L (20-28)
Urinalysis Glucose +++
Protein ++
Moderate bacteria seen
Cultures of blood and urine are requested and he is treated with an intravenous sliding scale insulin.
Which of the following IV fluids would you prescribe in conjunction with the insulin sliding scale for this patient?
What virus has a single stranded RNA genome and a 3% vertical transmission rate through blood?
What factor is linked to a higher likelihood of developing hepatocellular carcinoma?