A 25-year-old woman has been experiencing fatigue and sluggishness for the past three weeks, along with discomfort in the left upper quadrant of her abdomen. She had a UTI not long ago, which was treated with amoxicillin. However, she ceased taking the medication due to a rash that spread throughout her body. What is the probable cause of her exhaustion?
You have just received a 70-year-old woman into the resus room who had a witnessed collapse after complaining of chest pain. There was no pulse and CPR was performed at the scene. CPR is ongoing upon patient arrival in the Emergency Department. Pulse check demonstrates no palpable central pulse and there is no respiratory effort. A 3-lead ECG demonstrates no coordinated electrical activity or recognisable complexes, looking very much like a wandering flat line.
What is the most appropriate management of this patient?
An 80-year-old man with a history of recurrent falls attends the Elderly Care Clinic with his daughter. He also has a history of mild dementia, congestive heart failure, coronary artery disease, hypertension and type 2 diabetes. He takes furosemide, lisinopril, amitriptyline, aspirin, metoprolol, olanzapine and simvastatin. He lives by himself in a house in which he has lived for 30 years and has help with all activities of daily living. On examination, he appears frail, has mild bruising over both knees from recent falls and has reduced proximal lower-extremity muscle strength.
Which of the following interventions will decrease his risk of falling in the future?
A 35-year-old woman is brought to the Emergency Department following a fall off a ladder. She was witnessed to have lost consciousness at the scene and remained confused with the ambulance personnel. She is complaining of a headache and has vomited three times. Her eyes are open to voice and she is able to squeeze your hand using both hands, when asked, and wiggle her toes. She is confused about what has happened and does not remember falling. Her pupils are equal and reactive.
How would you manage this patient?
A 21-year-old woman is referred to the Emergency Department by her General Practitioner (GP) with a 4-day history of right flank pain, dysuria and fever. Urosepsis is suspected, and the Sepsis Six Pathway is implemented in the Emergency Department.
Which of the following is part of the ‘Sepsis Six’, the six key components to managing sepsis?
Your consultant asks you to monitor a 93-year-old woman on a General Medical Ward admitted with a lower respiratory tract infection who the nurses say becomes really confused at night. She scores 28/30 on Mini-Mental State Examination (MMSE) on two occasions in the daytime. Between these two results, on a night when you are on call, you completed the examination and found she scored only 18/30. She also complained of animals running around the room.
What is the most likely reason for her cognitive impairment?
A 70-year-old man with a history of hypertension, coronary artery disease and depression underwent bypass surgery last night. His depression has responded well to selective serotonin reuptake inhibitors (SSRIs) and there is no past history of psychosis. His blood pressure is also well controlled with medications. The following morning, he develops confusion, agitation and irritability, tries to remove his intravenous (iv) lines and wants to run away from hospital. His level of consciousness fluctuates, and at times he forgets who he is. He is given a neuroleptic drug and appears much improved.
What is the most likely diagnosis?
When requesting an investigation, it is important to consider the potential benefits and harms to the patient. Among radiographic investigations, which ones are associated with the highest radiation exposure?
You are with the on-call anaesthetist who has been asked to see a 30-year-old man blue-lighted into the Emergency Department. The patient complains of being stung by a wasp while running and reports his arm becoming immediately swollen and red. He kept running but, within a few minutes, began to feel very light-headed and had difficulty breathing. On examination, the patient looks flushed and has a widespread wheeze on auscultation. Blood pressure 76/55 mmHg, heart rate 150 bpm, respiratory rate 32 breaths/minute.
Which of the following is the best initial treatment?
A 55-year-old man is brought by ambulance to the Emergency Department following a high-speed road traffic incident. He was ejected from the vehicle and sustained a severe head injury. His Glasgow Coma Scale (GCS) score is E1 V1 M2. Other injuries include an unstable pelvic fracture (secured with a binder) and bruising to his anterior chest wall. His heart rate is 100 bpm with a blood pressure of 70/40 mmHg. Additional history from a family member includes:
Allergy – penicillin
Past medical history – hypertension, high cholesterol
Drug history – bisoprolol.
Which one of the following would be the fluid of choice for supporting his blood pressure?