A 25-year-old woman has experienced difficulty with lactation during the first week after giving birth to her second child. She successfully breastfed her first child for nine months. She delivered at full term and suffered from a significant postpartum hemorrhage six hours after delivery. She received an IV oxytocin infusion and a blood transfusion. What is the most probable location of the lesion?
A young girl requires an episiotomy during labour. The incision should be made:
A 42-year-old man is brought to the Emergency Department (ED) after being involved in a motor vehicle accident, in which he was thrown from a motorcycle. In the ED, the patient is unresponsive. Neurological examination shows intact pupillary and corneal reflexes, but the rest of the examination cannot be completed. Thirty minutes later, computerised tomography (CT) reveals uncal herniation of the right temporal lobe, and the patient is rushed to surgery.
What physical examination finding change is most consistent with this patient’s presentation?
An 80-year-old man is brought to the Emergency Department by his daughter after being found collapsed at home by his caregiver. He is complaining of a headache and appears confused. The patient has a history of an irregular heartbeat and takes digoxin and warfarin. On examination, there is no evidence of trauma or injury. The patient is confused with a Mini Mental score of 24/30 and is slightly drowsy but can be easily awakened. He has mild weakness in his left arm and leg, and the left plantar response is extensor. Urgent blood tests reveal a haemoglobin level of 111 g/l (normal range: 135-175 g/l), an INR of 5.7 (usual range for this patient: 2-3), and a urea level of 9.6 mmol/l (normal range: 2.5-6.5 mmol/l). An urgent CT scan is ordered. What is the most likely finding on the CT scan?
A 70-year-old man arrives at the Emergency Department with sudden onset of dizziness and hearing loss in his right ear that occurred three hours ago. He has fallen twice since then and was assisted by his daughter to get to the hospital. He reports feeling like the room is spinning and has nausea but has not vomited. Which artery territory is most likely involved in this stroke?
A 52-year-old woman presents to her General Practitioner for recent onset of acute back pain. For the last three months, she has been having a burning sensation and tingling of the hands and feet. Her past medical history includes hypertension, diabetes, coronary artery disease and chronic obstructive pulmonary disease (COPD). She is on medication for her hypertension and diabetes which are well controlled. X-ray of thoracic vertebrae demonstrates punched-out lytic lesions.
Her laboratory investigation report shows the following abnormalities:
Investigations Results Normal values
Calcium 3.2 mmol/l 2.2–2.6 mmol/l
Blood urea nitrogen (BUN) 15 mmol/l 2.5–6.5 mmol/l
Creatinine 130 μmol/l 50–120 μmol/l
Haemoglobin 98 g/dl 115–155 g/l
What is the most appropriate next investigation in this patient?
A 25-year-old man experiences a severe motorbike injury and is rushed to the Resuscitation Department of the Emergency Department. Upon arrival, his vital signs are recorded as follows:
Blood pressure – 200/120
Heart rate – 45 bpm
Saturation – 95% on 4 l of oxygen
What is the most probable diagnosis?
A 35-year-old man presents with complaints of numbness in his lower extremities. He has no significant medical history. Upon physical examination, there is a loss of proprioception on his left side below the umbilical line, and complete loss of sensation at the umbilical line. Furthermore, there is a loss of thermal and pain sensation in the groin area and below, on the right side. Radiological imaging reveals a mass on the spine. What is the most likely location of the mass?
A patient has returned to the ward, following a neurosurgical procedure to remove a large benign cyst. Over the next few hours, she becomes less alert and the neurosurgeon is recalled. The patient is unable to deviate her right eye medially. At rest, her eye appears to point downwards and laterally and the right pupil appears to be dilated.
Which nerve has been affected?
A 75-year-old man with a long history of back pain complains of severe pain in the thoracic spine. When the patient was 40-years-old, he underwent spinal fusion surgery where the T5 and T6 vertebrae were fused together with metal rods. His consultant decides to order a diagnostic imaging study of the thoracic spine.
Which of the following imaging modalities would be the MOST appropriate to order, based on the patient’s past surgical history?