A 22-year-old woman presents to her dermatologist with a 4-year history of acne on her back, chest and face. She has comedones, pustules and scars that have not improved with previous treatments. The dermatologist decides to prescribe isotretinoin. What other medication should be prescribed alongside this?
A 28-year-old builder comes to the GP complaining of large itchy silvery white scaly patches on his elbows and knees. He has no history of skin problems, but his father had psoriasis. What is the most suitable initial treatment to prescribe?
A 27-year-old woman is worried about the appearance of her toenails. She has noticed a whitish discoloration that extends up the nail bed in several toes on both feet. After confirming a dermatophyte infection, she has been diligently cutting her nails and applying topical amorolifine, but without success. What is the best course of treatment for her condition?
A 42-year-old West Indian diplomat, while on secondment in the United Kingdom, develops an uncomfortable raised rash on the anterior aspects of both her lower legs. She has prided herself with her remarkably good health over the years. She has recently visited Nigeria, Guyana and Vietnam for her work.
What would be the most appropriate initial investigation to conduct?
A 57-year-old accountant presents with an acute onset of widespread blistering of the skin. She is usually healthy but has been taking regular ibuprofen for the past two days due to a headache.
On examination, the patient has numerous tense bullae across the trunk and limbs. There is no involvement of the mouth. The dermatologist suspects bullous pemphigoid and wonders which adhesive structure is disrupted by autoimmune mechanisms in this condition.
A 68-year-old man arrives at the emergency department with a 24-hour history of epigastric pain that radiates to his back and vomiting. The doctors diagnose him with pancreatitis after his serum amylase levels come back at 2000. They also run some additional blood tests and find the following results:
– WCC: 22 ×109/L (Neutrophils: 17.2)
– Hb: 155 g/L
– Urea: 18.2 mmol/L
– Creatinine: 105 μmol/L
– AST: 250 IU
– LDH: 654 IU
– Calcium: 2.3 mmol/L
– Albumin: 38 g/L
– Glucose: 7.5 mmol/L
– PaO2: 9.9 KPa
What is the Modified Glasgow score for this patient?
A 65-year-old man has been brought to the hospital after collapsing at his workplace. Upon examination, he is found to be in a comatose state without response to visual stimuli, but he does extend his limbs in response to painful stimuli and occasionally makes incomprehensible sounds. His blood pressure is 164/88 mmHg, pulse rate is 98 beats per minute, and he exhibits hyperreflexia on the left side with bilateral extensor plantar responses. What is his Glasgow coma scale score?
A 50-year-old man is brought to the hospital by the police after being found unconscious on the street. He appears disheveled and smells strongly of alcohol. Despite attempts to gather information about his medical history, none is available. Upon examination, his temperature is 35°C, blood pressure is 106/72 mmHg, and pulse is 52 bpm. He does not respond to commands, but when a venflon is attempted, he tries to grab the arm of the medical professional and makes incomprehensible sounds while keeping his eyes closed. What is his Glasgow coma scale score?
A 57-year-old woman presents to the Emergency department with increasing lethargy. She has a history of drinking a bottle of vodka daily and has been experiencing persistent vomiting for the past week.
On examination, her pulse is 96/min and blood pressure is 109/70 mmHg. The following blood results are obtained:
– pH 7.32 (7.36-7.44)
– PaO2 12.0 kPa (11.3-12.6)
– PaCO2 3.1 kPa (4.7-6.0)
– Standard bicarbonate 10 mmol/L (20-28)
– Base excess −8 mmol/L (+/−2)
– Lactate 1.2 mmol/L (0.5-2.2)
– Sodium 142 mmol/L (137-144)
– Potassium 3.4 mmol/L (3.5-4.9)
– Urea 6.5 mmol/L (2.5-7.5)
– Creatinine 72 µmol/L (60-110)
– Plasma glucose 3.4 mmol/L (3.0-6.0)
– Urine analysis Ketones +++
What is the most appropriate treatment for this patient?
A 75-year-old widower is brought to the Emergency department after being found collapsed at home. His wife passed away recently and he has been struggling with depression. He has a history of stable angina and takes atenolol for it.
During the examination, his blood pressure is 80/35 mmHg and he is bradycardic. His first and second heart sounds are audible, his oxygen saturation is 95%, and his chest is clear. The cardiac monitor shows a heart rate of 20 beats per minute, and the ECG shows a junctional escape rhythm without changes of ischaemia.
What would be the most appropriate initial intervention?