A 72-year-old male is recovering from carotid endarterectomy for an 80% stenosis of the carotid artery. After a smooth recovery period, the registrar examined the patient’s cranial nerves. Upon requesting the patient to protrude his tongue, it was observed that the tongue deviated towards the right side of the patient. Which nerve has been impacted?
A 68 year old male has recently undergone transurethral resection of the prostate (TURP) with the use of 1.5% glycine as the irrigation fluid. The operation took longer than expected (1 hour 45 minutes) due to the size of the resection required for optimal gland flow. The patient is now exhibiting signs of agitation, confusion, and worsening breathlessness. A venous blood gas reveals that the patient is hyponatremic (118 mmol/l). What is the probable diagnosis?
A 50-year-old woman arrives at the emergency department with severe pain in her right upper quadrant, along with a fever, rapid heart rate, and fast breathing. What is the most probable diagnosis for her condition?
A 42-year-old female presents to the emergency department with severe pain in her right upper quadrant and vomiting. Upon examination, she is found to be pyrexial and has tenderness and peritonism in the right upper quadrant. There is more pain during inspiration on subcostal pressure in the right upper quadrant than in the left. Her bilirubin level is 9 mol/L (normal range: 1-22), amylase level is 50 U/L (normal range: 50-130), hemoglobin level is 128 g/L (normal range: 115-165), platelet count is 172 ×109/L (normal range: 150-400), and white cell count is 15 ×109/L (normal range: 4-11). What is the most likely diagnosis?
An 87-year-old man is brought into the emergency department by ambulance. He was found on his bathroom floor early this morning by his caregiver. He fell over last night, and had been unable to get up since then. He is now complaining of generalised aches and pains. He has no past medical history and does not take any regular medications.
On examination, he is cold and appears frail; he has a heart rate of 70/minute, and a blood pressure of 130/80 mmHg. His urine is also “muddy-looking’.
Blood tests showed the following:
pH 7.29
Bicarbonate 15 mmol/l
Creatine kinase 1559 u/l
Creatinine 301 µmol/l
Potassium 5.7 mmol/l
Routine blood tests a few weeks ago showed:
pH 7.41
Bicarbonate 27 mmol/l
Creatine kinase 99 u/l
Creatinine 61 µmol/l
Potassium 4.2 mmol/l
What is the underlying pathophysiology of this patient’s acute kidney injury (AKI)?
A 49-year-old woman presents to the emergency department with a 6 day history of severe vomiting and diarrhoea after returning from a recent trip to Africa. She reports feeling weak and lethargic, and has been struggling to keep down food and drink.
Upon initial assessment, she presents with dry mucous membranes, reduced skin turgor, cool extremities, and a non-visible jugular venous pressure. She is producing dark brown urine and is clinically oliguric over a 24-hour measurement.
Her initial blood tests reveal elevated levels of urea and creatinine: Urea 33 mmol/L (2.0 – 7.0) and Creatinine 320 µmol/L (55 – 120). She is given fluid therapy and antibiotic treatment for her gastroenteritis.
Three days later, she appears clinically rehydrated and is apyrexial, but still oliguric. However, her blood tests reveal further deterioration: Urea 39 mmol/L (2.0 – 7.0) and Creatinine 510 µmol/L (55 – 120). Urinalysis and microscopy reveals muddy brown granular casts.
What is the underlying cause of her worsening urea and creatinine levels?
At what age is it crucial to implement intervention for pre-lingually deaf children to achieve language acquisition comparable in speed and completeness to that of hearing children?
A 30-year-old female patient presents to the emergency department with burns to her face, neck, right arm, and upper chest after a vaping device exploded. She has burns covering 15% of her body and weighs 55kg. Using the Parkland formula provided, calculate the amount of fluid replacement she will receive after 12 hours.
A 25-year-old woman is scheduled for surgery to remove her appendix. She has a history of asthma since the age of 16 and is currently taking a high dose inhaled corticosteroid and theophylline. Despite this, she experiences breathlessness and uses her reliever several times a week. She has been to the emergency department twice in the past year due to asthma attacks. Her most recent peak flow measurement was 70%. She does not smoke or drink alcohol.
As a medical assistant, you are asked by the anesthesiologist to determine the ASA grade for this patient.
A 26-year-old woman weighing 70kg is brought to the emergency department with burns covering 25% of her body surface area.
Using the Parkland formula, calculate the volume of Hartmann’s solution that is recommended to be given in the first 8 hours after the burn.