A 50-year-old man with a history of intravenous drug use presents with abnormal blood results. His test results show Hepatitis B surface antigen positive, IgG Anti-HBc antibody positive, IgM Anti-HBc antibody negative, and Anti-Hepatitis B surface antibody negative. What is the most likely diagnosis for this patient?
Which of the following is the least likely to worsen bronchospasm in severe asthma?
A 16-year-old girl weighing approximately 70 kg is brought to the Emergency department in cardiac arrest. She was found collapsed at home surrounded by empty packets of amitriptyline 25 mg. The ambulance service reports that she had a weak pulse and no respiratory effort. She has been intubated and is being ventilated by bag-valve mask. The presenting rhythm is a sinusoidal supraventricular tachycardia with wide QRS complexes. Blood pressure is barely recordable but a weak carotid and femoral pulse are palpable.
Immediate arterial bloods gases are obtained and reveal an arterial pH of 6.99 (7.35-7.45), pO2 of 11.8 kPa (11.0-14.0), pCO2 of 5.9 kPa (4.5-6.0), HCO3- of 9.6 mmol/L (16-22), base excess of −19.7 mmol/L (-2 to +2), lactate of 7.4 mmol/L (0.5-2.0), potassium of 4.9 mmol/L (3.3-5.5), and glucose of 4.8 mmol/L (5.0-7.0).
What is the most appropriate next step?
A 50-year-old runner experiences chest pain and collapses while jogging. He is brought to the Emergency department within an hour. Upon arrival, he is conscious and given a sublingual nitrate which provides some relief. His heart rate is 90 beats per minute and his blood pressure is 120/85 mmHg. An ECG reveals 3 mm of ST segment elevation in leads II, III, AVF, V5 and V6. What is the most appropriate next step in managing this patient?
You are summoned to the assessment unit to evaluate a 65-year-old man who has been experiencing fevers and purulent green sputum for the past three days. He has no significant medical history and is not taking any regular medications. He is eager to return home as he is the primary caregiver for his ailing father.
During the examination, you observe that the patient is alert and oriented, but has bronchial breathing at the right base and a respiratory rate of 32 breaths per minute. His vital signs are as follows: HR 115 regular, BP 88/58 mmHg, O2 92% room air.
Initial blood tests reveal a WCC of 13.2 ×109/L (4-11) and urea of 8.5 mmol/L (2.5-7.5).
What is the most appropriate course of action?
A 78-year-old male is brought to the Emergency department by ambulance after experiencing a cardiac arrest. The ambulance crew is currently performing resuscitation attempts. Upon arrival, the patient has been intubated and connected to a defibrillator monitor, which shows a slow sinus rhythm (pulseless electrical activity) at a rate of 30 complexes per minute. The patient has been administered the full drugs protocol in accordance with the latest Adult Advanced Life Support guidelines. What do these guidelines recommend regarding the use of adrenaline during cardiac arrest?
A 26-year-old man with a history of asthma is admitted to the hospital for a left lower lobe pneumonia. He is prescribed amoxicillin, but within two minutes of taking the antibiotic, he complains of feeling unwell. A rapidly developing, erythematosus, macular rash appears on his trunk and limbs, along with large wheals on his torso. He also experiences lip and tongue swelling and a harsh wheeze is heard when his chest is auscultated. His blood pressure is 84/39 mmHg, and his heart rate is 167 bpm, which is determined to be a sinus tachycardia when connected to cardiac monitoring. His oxygen saturation levels are at 90% on air, so he is put on high flow oxygen.
What is the most appropriate drug to administer next?
As the foundation year doctor on ward cover, you are asked to assess a 75-year-old male who was admitted to the cardiac care unit five hours ago due to chest pain. The patient has been given morphine, aspirin, clopidogrel, enoxaparin, and metoprolol. However, he has recently experienced a sudden worsening of chest pain, and his heart rate has dropped to 30 beats per minute. His other vital signs are BP 140/85 mmHg, O2 98%, and RR 18. An ECG has been conducted, revealing complete heart block. What is the most probable cause of this sudden development?
A 27-year-old soccer player suddenly collapses during a game. He is immediately taken to the Emergency department where he is diagnosed with ventricular tachycardia. Despite successful defibrillation, he experiences a recurrence of ventricular tachycardia and unfortunately passes away after prolonged resuscitation. The 12 lead ECG taken after resuscitation reveals left ventricular hypertrophy. What is the probable diagnosis?
A 65-year-old male presents with a one day history of right-sided chest pain and dyspnoea that has worsened throughout the day. He underwent a right hip replacement and was discharged from BUPA one week ago. On examination, his temperature is 37.5°C, pulse is 96 bpm, blood pressure is 138/88 mmHg, and oxygen saturations are 90% on air. There are no specific abnormalities on chest examination, but his chest x-ray shows consolidation at the right base. The ECG is also normal. What is the most appropriate investigation for this patient?