As a junior doctor in a surgical firm, you are faced with a 54-year-old female patient who has metastatic breast cancer. She has been admitted due to worsening abdominal swelling and ascites. Despite being recommended chemotherapy, she has refused it for the past 6 weeks and opted for herbal treatment instead. Unfortunately, her condition has deteriorated, and she is experiencing significant pain. What steps do you take in this situation?
A 75-year-old woman is scheduled for a hip replacement at 2 pm. It is currently 11:30 am and she admits to having a cup of black coffee earlier. What should be the next course of action?
A 65-year-old woman comes to the clinic complaining of sudden pain in her right groin. She mentions that she had noticed a swelling in the area on and off for a few years, but it never bothered her before. She denies any nausea, vomiting, changes in bowel habits, or weight loss.
Upon examination, the abdomen appears normal, but there is a tender and irreducible swelling below and to the side of the pubic tubercle.
What is the probable diagnosis?
As an FY1 doctor, you are summoned to attend an unconscious 64-year-old woman lying on the floor of a ward. Upon assessing her airway, you notice that it appears clear, but you can hear snoring. However, the snoring ceases when you perform a head tilt, chin lift, and jaw thrust. Upon auscultation, her chest is clear with good bilateral airflow, and her trachea is central. Her peripheral capillary refill takes more than 2 seconds. Her oxygen saturation is 96% on 4L of oxygen, her pulse is weak and regular at 105/min, her respiratory rate is 16/min, her blood pressure is 98/54 mmHg, and her temperature is 36.6 ºC.
What is the most appropriate immediate course of action?
A 19-year-old man is brought to the emergency department resus after jumping from a building. The enhanced trauma team is coordinating his treatment as he had a GCS of 3 and required intubation and ventilation. Upon examination, he is found to have reduced chest expansion and a chest drain is inserted. Further assessment reveals bilateral calcaneus fractures, a fractured pelvis, multiple rib fractures, and multiple vertebral fractures in his lumbar region. After 15 minutes, the chest drain has drained 2 litres of blood and is still actively draining. What is the most appropriate course of action?
A 27-year-old cyclist is struck by a bus traveling at 30mph. Despite not wearing a helmet, he is conscious upon arrival with a GCS of 3/15 and is intubated. A CT scan reveals evidence of cerebral contusion, but there are no localizing clinical signs. What is the best course of action?
A 55-year-old male with hypercalcaemia secondary to primary hyperparathyroidism presents with renal colic. An ultrasound scan reveals ureteric obstruction caused by a stone. Despite multiple attempts at stone extraction, the stone remains lodged. The patient is now experiencing sepsis with a fever of 39.5ºC and has been administered antibiotics. What is the optimal plan of action?
A 72-year-old male is brought to the emergency department by his daughter. His daughter reports that 3 days ago, he fell down the stairs and hit his head. Initially, he seemed fine and did not want to go to the hospital. However, his daughter is now concerned as he has been acting confused on and off, which is unusual for him.
The patient has a medical history of atrial fibrillation, which is managed with warfarin. He also has well-controlled high blood pressure and diabetes. He does not consume alcohol.
The patient is unresponsive and unable to provide a history. During the neurological examination, there is no weakness in the face or limbs.
What is the most likely diagnosis based on this information?
A 38-year-old woman comes to her GP complaining of breast discharge. The discharge is only from her right breast and is blood-tinged. The patient reports feeling fine and has no other symptoms. During the examination, both breasts appear normal without skin changes. However, a tender and fixed lump is palpable under the right nipple. No additional masses are found upon palpation of the axillae and tails of Spence. What is the probable diagnosis?
A 25-year-old woman presents to the emergency department complaining of right-sided back pain and dysuria that has been bothering her for the past two days. The pain is constant and severe, and it radiates from her renal angle to her groin. Upon examination, her temperature is 38.1ºC, her heart rate is 101 bpm, her blood pressure is 139/91 mmHg, and she has a tender renal angle with a palpable mass on the right side of her abdomen. What is the most appropriate investigation to evaluate her abdominal mass?