An 80-year-old man who lives alone in a cabin is brought to the Emergency Department by his son. He was found lying on the floor unconscious but later regained consciousness. He now reports experiencing a headache, nausea, difficulty breathing, and feeling faint. He does not smoke, drink alcohol, or use any recreational drugs.
Which of the following tests is most likely to result in a likely diagnosis of carbon monoxide (CO) poisoning?
A 50-year-old man with a history of hypertension, asthma and porphyria requires emergency surgery. His blood pressure and asthma are under control. What is the most suitable anaesthetic induction agent for the rapid sequence induction (RSI) procedure?
A 75-year-old woman, who is a nursing home resident, presents to the Emergency Department, complaining of a one-week history of a red swollen calf, nausea and ‘ants on her arm’. She is noted to be unsteady on her feet and cannot remember what medications she is on. Observations find her temperature is 38.6 °C, oxygen saturation 98%, blood pressure 90/60 mmHg, heart rate 90 bpm and respiratory rate 20 breaths per minute.
What is the most likely cause of her hypotension?
A 79-year-old woman presents with recent-onset confusion. She had been in her usual state of health until she was observed to be confused and agitated during dinner yesterday. This morning, she was alert and oriented, but later in the evening, she became completely confused, agitated, and hostile. She was subsequently transported to the Emergency Department by ambulance. Additional history reveals no prior instances of confusion, but she has experienced increased frequency of urination over the past few days.
What is the probable reason for her confusion?
A 65-year-old woman, whose children called for an ambulance due to concerns about her breathing, has an arterial blood gas (ABG) test done. She is a frequent visitor to the Accident and Emergency department and has been experiencing a cough and producing green sputum for the past 6 days. She is currently receiving long-term oxygen therapy (LTOT) at home. While on controlled oxygen therapy through a Venturi system, her ABG results are as follows:
Investigation Result Normal value
pH 7.232 7.35–7.45
CO2 8.9 kPa 3.5–4.5 kPa
O2 9.4 kPa 8.0–10.0 kPa
HCO3– 33 mmol/l 22.0–28.0 mmol/l
SaO2 89%
Lactate 2.1 0.1–2.2
Which of the following statements best describes this ABG?
A 65-year-old previously healthy man with a 3-day history of feeling unwell, difficulty tolerating oral fluids and symptoms of a cold, is referred to the hospital by his primary care physician. The senior Accident and Emergency (A&E) nurse triages him and takes his vital signs, which are mostly normal except for a slightly elevated heart rate (102 bpm). She also performs a 12-lead electrocardiogram (ECG) and draws blood for testing, but the results are pending. The nurse suspects that the ECG shows some abnormalities and consults with the A&E senior resident, who confirms that the QRS complexes are widened, P-waves are absent, and T-waves are abnormally large.
What is the most appropriate initial course of action?
A 93-year-old man is brought to the Emergency Department from a nursing home with a 4-day history of fever and lethargy. He has a background history of chronic urinary catheterisation for benign prostatic hyperplasia. On clinical examination, he is noted to be acutely confused. His temperature is 38.5 °C, and he has a heart rate of 97 bpm, blood pressure of 133/70 mmHg and a respiratory rate of 20 breaths per minute.
Investigation Result Normal value
White cell count 13 × 109/l 4–11 × 109/l
Blood glucose 6 mmol/l 4–10 mmol/l
Urinalysis
2+ blood
2+ leukocytes
1+ nitrites
NAD
What is the diagnosis for this patient?
An 80-year-old woman presents with a 4-day history of right upper quadrant pain. She has a past medical history of hypercholesterolaemia and obesity. On clinical examination, she is alert and has a temperature of 38.6 °C, a heart rate of 90 bpm, a respiratory rate of 14 breaths per minute, a blood pressure of 112/90 mmHg and oxygen saturations of 98% on room air. She has tenderness in her right upper quadrant. Murphy’s sign is positive.
Her blood test results are listed below:
Investigation Result Normal value
White cell count 3 × 109/l 4–11 × 109/l
Blood glucose 7.9 mmol/l 4–10 mmol/l
C-reactive protein (CRP) 44 mg/l 0–10 mg/l
Which of the following does this patient have?
You are asked by nursing staff to review a pediatric patient in recovery overnight. As you arrive, the nurse looking after the patient informs you that she is just going to get a bag of fluid for him. On examination, the patient is unresponsive with an obstructed airway (snoring). You notice on the monitor that his heart rate is 33 bpm and blood pressure 89/60 mmHg. His saturation probe has fallen off.
What is your first priority?
A 15-year-old with a known peanut allergy arrives at the Emergency Department after consuming a peanut butter sandwich. During the examination, she displays symptoms of anaphylaxis.
What is the initial sign that is likely to appear first in a patient experiencing anaphylaxis?