A 68-year-old man visits his doctor’s office, reporting a recent onset of a red, swollen, and hot great left toe. He denies any injury to the toe and has a medical history of hypertension, which is being treated with a single medication. The doctor suspects acute gout as the diagnosis.
What medication is most likely responsible for triggering the acute gout?
A 65-year-old woman complains of bilateral knee pain that has persisted for 4 months, despite taking paracetamol PRN. Her recent knee X-rays reveal moderate degenerative changes, and she has requested physiotherapy. What additional treatment should be initiated while waiting for physiotherapy?
A 33-year-old woman presents to the hospital with recent-onset renal impairment after experiencing sinusitis. Upon chest X-ray, multiple cavitating lung lesions are discovered. The medical team suspects granulomatosis with polyangiitis (GPA). What is the most effective blood test to confirm this diagnosis?
A 55-year old complains of difficulty breathing. A CT scan of the chest reveals the presence of an air-crescent sign. Which microorganism is commonly linked to this sign?
A 68-year-old man with known bronchial carcinoma presents to hospital with confusion. A computed tomography (CT) scan of the brain was reported as normal: no evidence of metastases. His serum electrolytes were as follows:
Investigation Result Normal value
Sodium (Na+) 114 mmol/l 135–145 mmol/l
Potassium (K+) 3.9 mmol/l 3.5–5.0 mmol/l
Urea 5.2 mmol/l 2.5–6.5 mmol/l
Creatinine 82 μmol/l 50–120 µmol/l
Urinary sodium 54 mmol/l
Which of the subtype of bronchial carcinoma is he most likely to have been diagnosed with?
A 36-year-old woman of African origin presented to the Emergency Department with sudden-onset dyspnoea. She was a known case of systemic lupus erythematosus (SLE), previously treated for nephropathy and presently on mycophenolate mofetil and hydroxychloroquine sulfate. She had no fever. On examination, her respiratory rate was 45 breaths per minute, with coarse crepitations in the right lung base. After admission, blood test results revealed:
Investigation Value Normal range
Haemoglobin 100g/l 115–155 g/l
Sodium (Na+) 136 mmol/l 135–145 mmol/l
Potassium (K+) 4.7 mmol/l 3.5–5.0 mmol/l
PaO2on room air 85 mmHg 95–100 mmHg
C-reactive protein (CRP) 6.6mg/l 0-10 mg/l
C3 level 41 mg/dl 83–180 mg/dl
Which of the following is most likely to be found in this patient as the cause for her dyspnoea?
A 40-year-old Afro-Caribbean man comes to the clinic complaining of fever, dry cough and joint pains. Upon examination, his chest is clear. He has several tender, warm, erythematous nodules on both shins. A chest X-ray reveals prominent hila bilaterally. What is the most probable diagnosis?
A 68-year-old retired plumber presents with progressive shortness of breath, haemoptysis and weight loss. He has a smoking history of 25 pack years.
A focal mass is seen peripherally in the left lower lobe on chest X-ray (CXR).
Serum biochemistry reveals:
Sodium (Na+): 136 mmol/l (normal range: 135–145 mmol/l)
Potassium (K+): 3.8 mmol/l (normal range: 3.5–5.0 mmol/l)
Corrected Ca2+: 3.32 mmol/l (normal range: 2.20–2.60 mmol/l)
Urea: 6.8 mmol/l (normal range: 2.5–6.5 mmol/l)
Creatinine: 76 μmol/l (normal range: 50–120 µmol/l)
Albumin: 38 g/l (normal range: 35–55 g/l)
What is the most likely diagnosis?
A 61-year-old man presents to the Respiratory Clinic with a history of two episodes of right-sided bronchial pneumonia in the past 2 months, which have not completely resolved. He has been a heavy smoker, consuming 30 cigarettes per day since he was 16 years old. On examination, he has signs consistent with COPD and right-sided consolidation on respiratory examination. His BMI is 18. Further investigations reveal a right hilar mass measuring 4 x 2 cm in size on chest X-ray, along with abnormal laboratory values including low haemoglobin, elevated WCC, and corrected calcium levels. What is the most likely diagnosis?
A middle-aged overweight woman visits the clinic accompanied by her husband. She expresses concern about feeling excessively tired during the day and experiencing frequent episodes of sleepiness.
Her husband reports that she snores heavily at night and sometimes stops breathing. Additionally, her work performance has been declining, and she is at risk of losing her job.
What is the most suitable initial step in managing this patient’s condition?