A 61-year-old man presents to his GP with chronic right upper quadrant pain and an outpatient ultrasound scan reveals multiple calculi in a thin-walled gallbladder. Additionally, an incidental finding of a 4.6cm diameter abdominal aortic aneurysm is noted. What is the most suitable approach for managing his abdominal aortic aneurysm?
You are a healthcare professional working in the emergency department during the winter season. A patient, who is in his 50s, is brought in by air ambulance after being involved in a car accident. The trauma team assesses him and conducts the necessary tests. The patient is found to have a fracture in his right radius and small frontal contusions on his CT scan. Both injuries are treated conservatively, and he is admitted to the observation ward. However, after a few days of observation, the patient remains confused, and his family reports that he has not spoken a coherent sentence since his arrival. What investigation is the most appropriate given the possibility of diffuse axonal injury?
A 83-year-old woman presents with urinary frequency and dysuria. She reports that her urine appears bubbly. Over the past year, she has been treated for UTI five times. Her medical history includes hypertension, which is managed with amlodipine. On examination, she has mild suprapubic tenderness but no other significant findings. Her vital signs are heart rate 88/min, blood pressure 128/84 mmHg, respiratory rate 22/min, temperature 37.3ºC, and saturation 93%. A urine dipstick reveals the following: Blood +, Protein +, Leucocytes ++, Nitrites ++. What is the most likely diagnosis?
A 42-year-old male presents to the emergency department with intermittent abdominal pain in the right upper quadrant (RUQ). The pain started 3 hours ago, and is described as a sharp pain that comes and goes. The pain does not radiate anywhere, but it has progressively worsened throughout the day.
Upon examination, the patient appears to be in pain at rest, but does not appear clammy or pale. He is very tender in the right upper quadrant, but no guarding or rebound tenderness is felt.
His vital signs are as follows:
Heart rate = 105 beats per minute.
Respiratory rate = 20 breaths per minute.
Blood pressure = 130/85 mmHg.
Temperature = 38.5ºC.
What is the most appropriate next investigation to perform?
A 54-year-old woman presents to the Emergency Department with sudden onset upper abdominal pain radiating to the back. She reports experiencing similar pain in the past, especially after eating, but this episode is the most severe. Her medical history includes type 2 diabetes mellitus, chronic kidney disease (CKD), and hypercholesterolemia. She does not smoke or drink alcohol. On examination, there is tenderness to palpation of the epigastrium. Blood tests are ordered, and the results are as follows:
– Bilirubin: 28 µmol/L (3 – 17)
– ALP: 321 µmol/L (30 – 100)
– AST: 93 iu/L (3 – 30)
– Amylase: 1090 u/L (70 – 300)
– Calcium: 1.92 mmol/L (2.1 – 2.6)
What is the most appropriate next step in investigating the likely cause of her symptoms?
An 82-year-old man presents to the emergency department with severe constipation and abdominal pain. He has vomited five times in the last three days and has not passed air or faeces for the two.
Upon examination, his abdomen is very distended with diffuse tenderness and tinkling bowel sounds are heard on auscultation. The patient had undergone surgery for a perforated peptic ulcer two years ago. He has a medical history of asthma and type two diabetes.
What is the most likely diagnosis, and what is the gold standard investigation for confirming it?
A 45-year-old man comes to the Emergency Department complaining of severe retrosternal pain that has been ongoing for 3 hours. He reports having consumed a large amount of alcohol yesterday, resulting in significant regurgitation. On palpation of the chest wall, crepitus is detected. His ECG reveals sinus tachycardia. What test should be conducted to confirm the probable diagnosis?
A 50-year-old male is recovering on the surgical ward two days post-open inguinal hernia repair. He has no other past medical history of note.
He has not opened his bowels or passed wind for the last 48 hours. His abdomen is diffusely distended and tender. There is no rebound tenderness. There are no bowel sounds on auscultation. He is currently nil by mouth with a nasogastric tube placed.
His observations are as follows:
Respiratory rate 20 breaths per minute
Heart rate 110 beats per minute
Blood pressure 100/60 mmHg
Temperature 37.3ºC
Which of the following investigations is most likely to identify factors which are contributing to this patient’s postoperative complication?
A 68-year-old man presents to the Emergency Department with worsening abdominal pain over the past two days. The pain started in the lower left side of his abdomen and he has been experiencing diarrhoea. He has a medical history of hypertension, chronic kidney disease, and diverticular disease. On examination, his heart rate is 120 bpm, blood pressure is 135/80 mmHg, temperature is 38.5ºC, and oxygen saturation is 96% on air. His abdomen is tender throughout with involuntary guarding and rebound tenderness. Blood tests reveal the following results:
Hb 140 g/l Na+ 140 mmol/l Bilirubin 9 µmol/l
Platelets 730 * 109/l K+ 4.2 mmol/l ALP 70 u/l
WBC 18.9 * 109/l Urea 6.3 mmol/l ALT 36 u/l
Neuts 16.1 * 109/l Creatinine 115 µmol/l γGT 57 u/l
Lymphs 2.0 * 109/l Amylase 8 u/l Albumin 35 g/l
Which diagnostic test would be most appropriate to confirm the diagnosis?
A 26-year-old man and his partner visit the GP with a complaint of left-sided testicular pain that has been bothering him for the past 5 days. Upon examination, the left testicle appears swollen and red, and the pain subsides when the testicle is elevated. There are no signs of penile discharge or palpable masses. The right testicle appears normal. What is the most probable causative organism responsible for this man’s condition?