A 76-year-old male with a history of COPD and metastatic lung cancer is admitted with worsening shortness of breath. After consulting with family, it is determined that active treatment, including fluids and antibiotics, will be withdrawn as this admission is likely a terminal event. However, two days later, the patient becomes restless and agitated. What is the best course of action in managing this situation?
An 80-year-old man has been admitted to the geriatric ward for the past 2 weeks. He has recently been diagnosed with metastatic lung cancer. During the morning ward round, he expresses dissatisfaction with his pain management. He is currently taking oral morphine sulphate 20 mg four times a day, codeine 30mg four times a day, and regular ibuprofen. What is the appropriate dose of oral morphine for breakthrough pain in this patient?
A 63-year-old woman with metastatic breast cancer complains of worsening dyspnea. She is undergoing chemotherapy treatment. During the physical examination, a third heart sound is heard and the apex beat is displaced to the anterior axillary line in the 6th intercostal space. Which chemotherapy drug is most likely causing these symptoms?
A 49-year-old woman receives a red blood cell transfusion in the emergency department after a car accident. She develops a fever and becomes anxious after 30 minutes. The transfusion is stopped and the following observations are made: respiratory rate 21 breaths per minute, heart rate 74 bpm, saturations 98% (room air), blood pressure 125/85 mmHg, temperature 39ºC. The patient is comfortable at rest and chest auscultation reveals no wheezing. What is the most appropriate treatment for this patient’s reaction?
A 54-year-old woman arrived at the hospital complaining of chest pain and difficulty breathing. She has a history of left breast cancer and had undergone local wide excision recently. She is scheduled to begin radiotherapy soon. After a diagnostic workup, it was discovered that she has a segmental pulmonary embolism. Her blood tests indicate good renal function. What is the most suitable treatment option for this diagnosis?
A 15-year-old Afro-Caribbean girl arrives at the emergency department with complaints of left hip pain. There is no history of recent trauma, but the patient has a medical history of sickle cell disease and has been admitted multiple times in the past with similar symptoms. What is the appropriate management plan for this patient?
A 30-year-old male presents with progressive weakness and fatigue over the past year. He reports difficulty achieving and maintaining an erection with his new partner, which is a new symptom for him. Laboratory tests reveal elevated ferritin levels. The patient is started on a treatment plan that involves regular phlebotomies.
What is the most effective way to monitor the patient’s response to treatment?
A 30-year-old woman has just been diagnosed with Hodgkin’s lymphoma and has started her first day of chemotherapy. However, she has been feeling unwell since then and her U&E results show abnormalities such as hyperkalaemia, hyperphosphataemia, and hypocalcaemia. What prophylaxis is used to prevent the complication that this woman has experienced?
A 30-year-old man presents with fatigue, joint pain, and abnormal liver function tests. After investigation, he is diagnosed with hereditary hemochromatosis. His wife undergoes genetic testing and is found to not carry the disease. What is the likelihood that their child will develop hemochromatosis?
A 19-year-old man is being examined for excessive bleeding after a tooth extraction. The test results show:
Platelet count: 173 * 109/l
Prothrombin time (PT): 12.9 seconds
Activated partial thromboplastin time (APTT): 84 seconds
Which clotting factor is he most likely deficient in?