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.
A 28-year-old male arrived at the emergency department with a humeral shaft fracture after falling from a rooftop during a party. He admits to taking recreational drugs before the incident but is unsure of what he consumed. After receiving analgesia, he undergoes surgery to fix his fracture with a coaptation splint and functional brace. The next day, he reports suprapubic pain and difficulty urinating, leading to a diagnosis of acute urinary retention. What drug is the probable cause of his urinary retention?
A patient arrives at the hospital reporting he took a significant overdose of paracetamol over 12 hours ago.
On exam, he appears unwell and has significant right upper quadrant tenderness and so acetylcysteine treatment was commenced.
An arterial blood gas with other specific tests taken 48 hours post first ingestion shows:
pH 7.20 7.35–7.45
pC02 5.0 kPa 4.4–5.9
pO2 11.0 kPa 10.0–14.0
HCO3 10 mmol/L 22–28
Lac 6 mmol/L <2 Creatinine 700 μmol/L 53–106 Bilirubin 400 μmol/L 2–17 Prothrombin time (PT) 20 sec 11-15 What result indicates that this case meets the King’s College Hospital criteria for liver transplantation?
A 55-year-old man, who has recently started a new relationship, presented with depression. He reported a decrease in libido, which was affecting his relationship. The physician decided to initiate testosterone therapy after conducting some blood tests.
Which of the following routes should not be used to administer testosterone?
A 25-year-old man is rushed to the emergency department after admitting to swallowing an unknown amount of pills following an argument with his partner. He cannot recall the name or purpose of the pills and estimates that he began taking them over an hour ago. On examination, his GCS is 14/15, blood pressure is 100/70 mmHg, and heart rate is 160/min. His respiratory rate is 30/min, and his pupils are dilated but reactive to light. An ECG reveals tachycardia and QRS widening (120ms). What is the most appropriate first-line treatment option for this likely diagnosis?
A 45-year-old man who works for a pest control company presents to the Emergency Department with profuse diarrhoea, vomiting and hypersalivation. On examination, you observe bilateral constriction of the pupils, excess lacrimation, salivation and muscle fasciculations. His heart rate is 34 bpm and his blood pressure is 86/52 mmHg. He is promptly transferred to the intensive care unit for suspected acute organophosphate poisoning. What is the most suitable course of action for this patient?
A 50-year-old construction worker presents to the Emergency Department with complaints of a headache and overall weakness. He reports feeling slightly disoriented and has been urinating more frequently than usual today.
During the examination, the patient appears sweaty, and his pupils are 2mm in diameter and reactive to light. Chest and abdomen examination revealed no abnormalities. However, at the end of the examination, the patient begins to vomit, without evidence of blood or bile in the vomitus.
The patient’s vital signs are as follows: respiratory rate 19/min; oxygen saturations 98% on air; temperature 36.6ºC; heart rate 50 beats per minute; blood pressure 102/62 mmHg.
What treatment should be initiated based on the likely diagnosis?
A 32-year-old male with a history of intentional overdose was urgently admitted to the hospital after ingesting 50 regular-strength aspirin tablets. He has a past medical history of anxiety and depression. On admission, he presented with increased respiratory rate of 25 breaths per minute, blood pressure of 111/77 mmHg, and heart rate of 110 beats per minute. He was also sweating profusely with a temperature of 38.1ºC. What is the best initial course of action for his management?
A 56-year-old woman is brought to the emergency department after ingesting a significant amount of prescription drugs. She was discovered at home with empty bottles of imipramine nearby. Despite appearing drowsy, she informs the doctor that she took the medications about 8 hours ago.
During the examination, the patient is found to be hypotensive, tachycardic, and drowsy. An ECG reveals a QRS width of 162ms. What treatment should be given?