You are evaluating a patient who presents with diplopia. When looking straight ahead, the patient’s right eye is elevated and abducted. When attempting to gaze to the left, the diplopia exacerbates.
What is the probable underlying cause of this issue?
A 25-year-old male blood donor presents with the following blood results:
Bilirubin 41 µmol/L
ALP 84 U/L
ALT 23 U/L
Albumin 41 g/L
Dipstick urinalysis normal
He has been experiencing symptoms of a cold, including a runny nose and dry cough. What is the probable diagnosis?
A 58-year-old man is discovered to have a prolonged corrected QT interval (QTc) of 480 ms on his pre-operative ECG. The anaesthetist suggests modifying one of his medications before the surgery. Which of the following drugs are recognized to cause QTc prolongation?
A 15-year-old girl is rushed to the emergency department by ambulance after experiencing difficulty breathing during a sports event. Despite using her salbutamol inhaler, she could not catch her breath. She has a history of asthma.
Upon initial assessment, her heart rate is 110 bpm, and her respiratory rate is 28 /min. She is unable to complete full sentences, and there is a widespread wheeze on chest auscultation.
Further investigations reveal the following results:
– PEFR 52% (>75%)
– pH 7.43 (7.35-7.45)
– pO2 10.9 kPa (11-14.4)
– pCO2 4.7 kPa (4.6-6.0)
What is the classification of this patient’s acute asthma episode?
A 35-year-old woman presents to the hospital after experiencing her first unprovoked seizure. She seeks guidance from the neurology clinic on whether she can continue driving as she needs to take her children to school. Although the neurologist has not yet diagnosed her with epilepsy, they plan to reassess her in 6 months. What recommendations should you provide to her?
A young man with asthma presented to the ED complaining of shortness of breath. He was unable to speak in complete sentences and his PEFR was 50% of predicted. His heart rate was 90/min and respiratory rate was 24/min. Despite using his regular inhaler, he did not experience any relief. The patient was given nebulised salbutamol, oral prednisolone and ipratropium bromide, and his acute treatment was discontinued 10 hours ago. Currently, his PEFR is 80% of predicted and he has been stable on discharge medication. The doctor’s notes indicate that he demonstrated proper inhaler technique. What other criteria must he meet before being discharged?
Liam, a 17-year-old boy, comes in for his annual asthma review. He has generally well-controlled asthma, with only one exacerbation requiring steroids this year. He takes 2 puffs of his beclomethasone inhaler twice daily, and salbutamol as needed, both via a metered-dose inhaler (MDI).
You decide to assess his inhaler technique. He demonstrates removing the cap, shaking the inhaler, and exhaling before placing his lips over the mouthpiece, pressing down on the canister while taking a slow breath in and then holding his breath for 10 seconds. He then immediately repeats this process for the second dose.
What suggestions could you offer to improve his technique?
A 50-year-old woman has presented to her physician with complaints of excessive thirst and frequent urination with dilute urine. She also experiences recurrent abdominal pain and constipation, along with weakness and fatigue that has affected her mood. The physician orders an ECG and blood tests, which reveal the following results:
Calcium 2.8 mmol/L (2.1-2.6)
K+ 4.3 mmol/L (3.5 – 5.0)
What is the most probable abnormality seen on the ECG?
A 55-year-old male with type 2 diabetes presents for his annual check-up. He has a history of angina after a previous heart attack and still smokes 10 cigarettes daily. His blood pressure is 145/88 mmHg, and he is in sinus rhythm. Evidence of neuropathy is present in his feet, but no ulcers are visible. He has background diabetic retinopathy and scars from previous photocoagulation therapy. His urine albumin/creatinine ratio is 20 mg/mmol, and his estimated glomerular filtration rate is 50 ml/min/1.73m2. His HbA1c is 51 mmol/mol (20-46).
What is the best intervention to preserve this patient’s kidney structure and function?
A 90-year-old man is referred to the memory clinic for evaluation due to his family’s concerns about his increasing forgetfulness in recent months. He scores 14/30 on the Mini Mental State Examination (MMSE). The consultant requests that you initiate treatment with an acetylcholinesterase inhibitor.
Which of the following drugs would you prescribe?