A 31-year-old man presented with decreased libido. He had read about testosterone in a magazine and ordered a test through an online laboratory, which showed a low level. He had a history of morphine addiction for the past 4 years and had recently started treatment at a detox clinic, where he was taking methadone orally. He smoked 15 cigarettes per day.
What is the most appropriate advice to give to this patient?
A previously fit and healthy 28-year-old woman attended the GP surgery complaining of headache. It is a unilateral, throbbing headache that has lasted up to 24 h. She also describes some photophobia. There have been a few recurrent attacks over the last month. Neurological examination is unremarkable. She is currently taking the oral contraceptive pill.
Which of the following is most suitable to reduce the frequency of the headache she described?
Which of the following statements about heparin-induced thrombocytopaenia (HIT) is accurate?
A 50-year-old man is recuperating from an appendectomy in the surgical ward. He is administered an antiemetic to alleviate post-anaesthesia nausea. After two hours, he is discovered contorting in his bed, incapable of communicating. His limbs are stiff and inflexible.
What drug would you prescribe to remedy his condition?
Samantha is 89-years-old and has been admitted to hospital for being ‘off-legs’. She is usually fit and well, walking 3 miles a day. Her only past medical history is of osteoarthritis in her hands for which she takes regular paracetamol with omeprazole for gastro-protection. Samantha’s daughter reports that Samantha has become gradually more confused over the preceding weeks. She has a NEWs (national early warning score) of 0. Her U&Es are reported back as:
Na+ 134 mmol/L (135 – 145)
K+ 3.2 mmol/L (3.5 – 5.0)
Mg 2+ 0.5 mmol/L (0.85 – 1.10)
Her renal function is at her baseline. What is the most appropriate initial management plan?
As a doctor on the renal ward, you come across a patient with chronic kidney disease (CKD) who is experiencing pain in their right calf. The patient reports that they noticed the pain after waking up this morning. Upon examination, you notice that the calf is mildly erythematosus, painful, and hard to touch. The circumference of the right leg is 3.5 cm more than the left. The patient’s physical observations are recorded, which show a respiratory rate of 13 breaths per minute, oxygen saturations of 99% on air, blood pressure of 110/85 mmHg, heart rate of 64 beats per minute, and a temperature of 36.7ºC. The patient is alert and well orientated.
You review the patient’s most recent blood results, which indicate the following: Na+ 141 mmol/L (135 – 145), K+ 4.0 mmol/L (3.5 – 5.0), Bicarbonate 25 mmol/L (22 – 29), Urea 6.8 mmol/L (2.0 – 7.0), Creatinine 184 µmol/L (55 – 120), and eGFR 12 ml/min (>90).
Based on the patient’s symptoms and medical history, what is the most appropriate initial treatment plan?
A 28-year-old woman is admitted with an overdose. She is currently taking antidepressants prescribed by her general practitioner and painkillers for a chronic back complaint. Other past medical history of note includes hypertension. On examination, she has a Glasgow Coma Scale (GCS) score of 7. Her pulse is 105 bpm and regular, and her blood pressure is 85/60 mmHg. Her pupils are sluggish and dilated.
Investigations:
Investigation Result Normal value
Haemoglobin 131 g/l 115–155 g/l
White cell count (WCC) 8.4 × 109/l 4–11 × 109/l
Platelets 201 × 109/l 150–400 × 109/l
Sodium (Na+) 141 mmol/l 135–145 mmol/l
Potassium (K+) 4.9 mmol/l 3.5–5.0 mmol/l
Creatinine 182 μmol/l 50–120 µmol/l
pH 7.15 7.35–7.45
pO2 8.1 kPa 10.5–13.5 kPa
pCO2 5.9 kPa 4.6–6.0 kPa
Bicarbonate 14 mmol/l 24–30 mmol/l
Which of the following is the most likely diagnosis?
A 28-year-old woman is admitted with an overdose. She is currently taking Antidepressants prescribed by her GP and painkillers for a chronic back complaint. Other past medical history of note includes hypertension. On examination she has a GCS of 7. Her pulse is 105/min regular and her BP is 85/60 mmHg. Her pupils are sluggish and dilated.
Investigation Result Normal value
Haemoglobin 131 g/l 115–155 g/l
White cell count (WCC) 8.4 × 109/l 4–11 × 109/l
Platelets 201 × 109/l 150–400 × 109/l
Sodium (Na+) 141 mmol/l 135–145 mmol/l
Potassium (K+) 4.9 mmol/l 3.5–5.0 mmol/l
Creatinine 182 μmol/l 50–120 µmol/l
pH 7.15 7.35–7.45
pO2 8.1 kPa 10.5–13.5 kPa
pCO2 5.9 kPa 4.6–6.0 kPa
Bicarbonate 14 mmol/l 24–30 mmol/l
Which of the following is the most likely diagnosis?
You are evaluating a new angiotensin-converting enzyme (ACE) inhibitor for lowering blood pressure in elderly patients. The half-life of the agent is 16 hours.
Which of the following reflects the likely dosing schedule for this agent in elderly patients?
A 35-year-old woman comes for a follow-up appointment with her physician after undergoing investigations for a 6-month period of hot flashes and absence of menstruation. The patient was previously informed that the results of a series of hormone profile tests indicate that she is experiencing premature menopause. The purpose of this appointment is to discuss management options for hormone replacement therapy (HRT). After the discussion, the patient decides to choose a Mirena intrauterine system (IUS) with additional daily estrogen. What is the recommended duration for the patient to continue with HRT?