You are discussing IVF therapy with a 36-year-old woman and her partner who are interested in starting a family. Would you like to discuss the option of administering a single injection of corifollitropin as an ovarian stimulant instead of a week-long daily FSH therapy?
A 20-year-old man was admitted to the Emergency Department after his roommate reported that he was afraid that the government had implanted a radio in his brain that was telling him to kill himself. Further evaluation revealed that he had many symptoms of schizophrenia and a decision was made to treat him with clozapine. Which statement about this drug is correct?
A 30-year-old woman is considering taking folic acid.
What is the primary benefit of taking folic acid in preparation for pregnancy?
A 36-year-old woman presents to the emergency department after being found confused by her partner. On direct questioning, she tells you that she has taken an overdose of 56 tablets of 20 mg amitriptyline around 12 hours ago.
On examination, she is alert with Glasgow coma scale 15. The abbreviated mental test score is 8/10. Observations are as follows: respiratory rate of 16 breaths per minute, pulse 160 beats per minute, blood pressure 100/60 mmHg, oxygen sats 98% on air and temperature 37.8 ºC. Examination reveals a regular pulse, heart sounds are normal and the chest is clear. There is hypertonia bilaterally and ophthalmoplegia. Both pupils are dilated.
Na 142 mmol/L (135 – 145)
K 4.0 mmol/L (3.5 – 5.0)
Bicarbonate 24 mmol/L (22 – 29)
Urea 3.3 mmol/L (2.0 – 7.0)
Creatinine 60 µmol/L (55 – 120)
Venous blood gas reveals a pH 7.38. ECG reveals a sinus tachycardia at rate 160 bpm, PRc 160 ms, QRS 170ms.
What initial treatment will you initiate?
A 14-year-old boy is admitted to the paediatric ward after a staggered paracetamol overdose the previous day. He was treated with N-acetylcysteine. On examination, he appears mildly jaundiced but is alert. His heart rate is 92 bpm, and his BP is 108/80 mmHg. There is right upper quadrant abdominal tenderness. Blood test results show: pH 7.35 (7.35-7.45), Prothrombin time (PT) 21 secs (10-14 secs), Activated partial thromboplastin time (APTT) 32 secs (25-35 secs), Bilirubin 22 µmol/L (3 – 17), ALP 70 u/L (30 – 100), ALT 40 u/L (3 – 40), Paracetamol plasma concentration is 160 µmol/L. What is the next step in management?
A 38-year-old man arrives at the Emergency Department complaining of sudden central crushing chest pain while at a social gathering. He is sweating profusely and describes his pain as severe. He has no significant medical or family history but admits to snorting a considerable amount of cocaine at the party. An ECG reveals 4 mm ST elevation in the anterior leads, indicating acute coronary syndrome (ACS). What other interventions should be considered in managing this patient, in addition to standard ACS treatment?
A 27-year-old woman arrives at the emergency department accompanied by her father. After a heated argument, the patient ingested a packet of her father’s depression medication and locked herself in her room. When the door was forced open, she was found lying on the floor in a drowsy state. As part of her evaluation, an electrocardiogram was performed, revealing a sinus rhythm with a heart rate of 98 beats per minute, PR interval of 100ms, QRS of 150ms, and QTc interval of 420ms. What is the most appropriate course of action based on these findings?
A 75-year-old man presents to the emergency department with a one-week history of diarrhoea, resulting in dehydration. He appears confused and drowsy, without significant medical history. Suddenly, a healthcare assistant alerts the team after the patient experiences a full-body seizure, lasting for two minutes. His latest blood tests reveal abnormal levels of Na+, K+, Bicarbonate, Ca2+, and Mg2+. What is the best initial approach to manage this patient?
A 67-year-old man complains of intense epigastric pain that spreads to his back. He reports the pain to be excruciating, with a severity of 9/10. He also experiences nausea and vomiting. His serum amylase levels are elevated, leading you to suspect acute pancreatitis.
What would be your initial approach to managing his acute pain?
A 68-year-old man with a history of uncontrolled hypertension experiences painful swelling in his right knee after starting a new medication prescribed by his GP. What is the most conclusive test to confirm his diagnosis?
The definitive investigation to confirm his diagnosis is crucial in determining the appropriate treatment plan for this patient.