🔵 34-year woman with recent H/O small bowel resection for Crohn’s disease was admitted with abdominal pain and intermittent diarrhea + On exam: Nothing significant + Investigation shows: K+, Most appropriate next step To dx >> SeHCAT testing (Dx: Bile acid diarrhea)
🔵 28 yrs known ulcerative colitis pt presented with rapidly enlarging ulcer on his Lt lower limb despite taking regular mesalazine + Most appropriate intervention >> Per oral Prednisolone (Dx: Pyoderma gangrenosum)
🔵 60 yrs pt is monitored on CCU post Percutaneous coronary Intervention for Inferior MI + 4 hours after PCI, he develops wide QRS + On exam: No chest or rhythm problem, No sacral or pedal edema + Most appropriate next step >> Observation only.
★ Post-PCI-wide QRS is normal, not necessarily imply a deterioration of prognosis.
🔵 45 yrs man was brought to the Emergency Dept following a road traffic accident due to his difficulty in seeing the car from the opposite side + On exploration: excessive tiredness, Bitemporal hemianopia + Investigation shows: High Prolactin + Most likely the cause of pt’s symptoms >> Non-functioning pituitary adenoma
🔵 77 yrs pt presented with symptoms of urinary frequency, difficulty in starting, dribbling, and nocturia + D/R/E shows: Smoothly enlarged prostate + Most appropriate intervention >> Finasteride (Dx: BEP)
★ Finasteride is a 5-alpha reductase inhibitor
🔵 73 yrs known Diabetic pt presented with pain in his Lt great toe + On exam: erythema and swelling over the proximal big toe + Investigation shows: High WBC X-ray toe shows: there is lucency and bone loss around the 1st metatarsal phalangeal joint + Most appropriate intervention >> Co-amoxiclav (Dx: Osteomyelitis)
🔵 32 yrs lady presented with approximately 600 ml post-partum hemorrhage She is now hypotensive and tachycardic + 0.9% NaCl and Oxytocin and ergometrine have been started + Most appropriate next step >> Tranexamic acid.
★ Tranexamic acid is the most appropriate intervention for large-volume post-partum hemorrhage
🔵 57 yrs woman was referred to the hepatology clinic for deranged LFTs + On exploration: she has DM, drinks 8 units per week, BP: 152/98 mmhG, BMI: 33 kg/m2 + Investigation shows: raised Liver enzyme + Most likely cause of Pt’s abm normal liver function >> Metabolism dysfunction associated steatohepatitis
🔵 65 yrs woman was recommended a 10-day course of enoxaparin following swelling in her Left calf + on 5 days blood test showed: a marked reduction of platelet count + Most likely the underlying cause of her low platelet >> Type -2 heparin-induced thrombocytopenia.
🔵 32 yrs old woman presented with perianal itching which is worse at night + On exam: Some scratch marks around the anus + Most appropriate intervention >> Mebendazole (Dx: Threadworm infection)
🔵 74 yrs old man known to have Ischaemic cardiomyopathy was admitted to E/D following a collapse due to 3 previous anterior myocardial infarctions + On exam: Pedal edema present + Pt is already on bisoprolol, Spironolactone, and furosemide + Ejection fraction: 25%, Wide QRS in ECG + Most appropriate intervention >> Cardiac Resynchronization therapy device with pacemaker.
🔵 72 yrs hypertensive pt on Ramipril now presented with tongue swelling, stridor, tachycardia, and HR: 110 bpm and systolic BP reduced by 50 mmHg + Medication is most likely to have contributed to this pt’s symptoms >> Ramipril.
🔵 71 yrs known Hypertensive and diabetic pt was brought to ED following the sudden onset of Rt sided face, arm, and leg weakness for 2 hours + On exam: BP: 156/90 mmHg + CT scan shows: Lt sided middle cerebral artery infarct + Most appropriate intervention >> Alteplase (As within thrombolytic window)
🔵 25 yrs female presented with intensely itchy rash on her elbow and buttocks and intermittent diarrhea + Investigation shows: Low Hb% + Most effective intervention is >> Gluten avoidance
🔵 49 yrs known GERD on regular omeprazole now presented with watery diarrhea for six months + colonic biopsy shows: Lymphocytic infiltration + Most likely cause of pt’s symptoms >> Microscopic Colitis
🔵 75 yrs woman was brought to ED with a complaint s of severe vomiting and watery diarrhea + On exploration: other members of the same home are also sick + Investigation shows :K+: 3.1 mmol/l, Creatinine: 155 mg/dl + Most likely cause of pt’s symptoms >> Norovirus.
🔵 62 yrs woman known with Rheumatoid Arthritis pt on methotrexate was brought to ED for her anemia+ On exam: Active synovitis affecting wrist and fingers + investigation shows: Hb%: 90gm/l, MCV: 81 fl + Immunoglobulin electrophoresis: Polyclonal increase in immunoglobulin + Most likely cause of this pt’s anemia >> Anemia of chronic disease.
🔵 35 yrs known Asthma pt presented with worsening feature of asthma + On exam: Bilateral wheeze, Peak flow is 320 liters/min (520 predicted) + Investigation shows: Aspergillus precipitant: positive, CXR shows: Patchy shadowing throughout both lung fields + Most appropriate intervention >> Prednisolone and itraconazole (Dx: Allergic Bronchopulmonary Aspergillosis)
🔵 62 yrs old man known to have end-stage renal disease on peritoneal dialysis now presented with abdominal pain and distension + On exam: Overnight bag collection is cloudy and temperature is 38.2 degrees, Tender abdomen + Organism most likely causes to this pt’s symptoms >> Staphylococcus epidermidis.
★ Coagulase-negative staphylococcus is the most common cause of peritoneal dialysis-associated peritonitis.
🔵 27 yrs relief worker presented with a severe fever, muscle aches following return from Kenya + On exam: has a fever, BP: 90/50 mmHg, he is drowsy+ Investigations shows: Hb%: 98 gm/l, Blood film shows: Falciparum malaria identified with 5% parasitemia + Most appropriate antimalarial regimen >> Artesunate (Dx: Severe Falciparum malaria)
🔵 24 yrs old man presented to ED following a collapse while playing rugby + On exam: BP: 80/50 mmHg, HR: 210 bpm, chest is clear + Most likely cause of pt’s tachycardia >> AV nodal reentrant tachycardia with RBBB.
★ For recurrent episodes >> Ablation is usually definite intervention
🔵 20 yrs man presented with passing tea-colored urine following suffering from a sore throat and cough 2 days ago + on the exam: Evidence of pharyngitis + Urinalysis shows: (Protein1+, Blood 3+) + Most appropriate next step >> Review in a clinic in 2 weeks
🔵 45 yrs British white was referred to pharmacologist for management of hypertension+ Exam: Ambulatory BP:159/92 mmHg, BMI: 26 kg/M2 + Most appropriate antihypertensive medication for this pt >> Ramipril
🔵 80 yrs old man presented with central chest pain + on exploration: chest pain comes many times each week and often regurgitates undigested food and fluids + On exam: the abdomen is soft, with no palpable mass + CXR shows: proximal esophageal dilatation + Most likely cause of Pt’s symptoms >> Achalasia cardia
🔵 A 24-year-old woman is referred to the dermatology clinic with a scaly patch affecting her left arm + Most likely dx >> Tinea corporis.
🔵 25 yrs known T1-DM presented with an episode of fainting episode + on the exam: BP: 120/80 mmHg, a postural drop of 30 mmHg on standing + Investigation shows: Low Na+, High K+: 5.1 mmol/l, HbA1C: 37 mmol/mol + Most appropriate intervention >> Hydrocortisone (Dx: Addison disease)
🔵 32 yrs Farmer presented with fever, jaundice, and bruising following a flu-like illness + On exam: the jaundiced sclera, number of bruises and pinpoint bleeding, tender Rt upper quadrant + Investigation shows: Low Hb%, Low Platelet count, raised Liver enzyme level + Most appropriate antibiotic intervention for this pt >> IV Benzylpenicillin (Dx: Weil disease)
🔵 56 yrs known end-stage cirrhosis of liver pt admitted with the rapid deterioration of renal function + On exam: BP: 90/70 mmHg, Ascites and pitting edema + Investigation shows: high K+, High Creatinine: [245 micromol/l (121 micromol/l was 4 weeks ago], Albumin: 22 gm/l + Most appropriate next intervention >> Terlipressin
★ Terlipressin is the initial intervention of choice for patients with hepatorenal syndrome type 1.
🔵 A 35-year-old lady was brought to the ED following a tonic-clonic seizure + On exploration: he was taking clozapine for a long time for bipolar disorder and recently started citalopram for his depression + On exam: BP:90/70 mmHg, GCS: 6 Pupil is pinpoint, HR: 105 bpm + Most appropriate intervention >> Intubation and ventilation
★ Clozapine concentrations are significantly increased by co-prescription with selective serotonin reuptake inhibitors such as citalopram.
★ GCS < 8, Is an indication of Intubation and ventilation
🔵 A 32-year-old pregnant lady came for review in the endocrine clinic + Glucosuria was detected and the OGTT test confirmed gestational DM + Most appropriate intervention for this pt blood glucose control >> Metformin.
🔵 19 yrs old man was admitted into ED following a cardiac arrest while working at his University dssk+ His brother died in sleep at age 21 + ECG record shows: Ventricular tachycardia before initial shock + Most likely cause of pt’s cardiac arrest >> Brugada syndrome.
🔵 78 yrs woman presented with urinary incontinence + On exploration: she has to visit the toilet several times and often does not make it to the toilet before she passes urine + She does not lose control when she strains and coughs + Recently diagnosed with some memory issue + Most appropriate intervention further >> Mirabegron (Dx: Urge incontinence)
★ Mirabegron is a beta-3 adrenergic agonist used in the treatment of pt with unstable bladder and urge incontinence
🔵 74 yrs known COPD pt presented with wheeze, cough, and SOB + Despite giving maximum medical treatment Blood gas analysis shows: pH: 7.2, paO2: 7.8 kPa, paCoP2: 7.5 kPa + Most appropriate next step >> Extensive intubation and ventilation.
★ Pt with type Ventilation where pH less than 7.2 is a strong indication for elective ventilation
🔵 36 yrs known ulcerative colitis pt presented with raised Liver enzyme and high Alkaline phosphatase + On exam: Vague Rt upper quadrant pain + investigation shows: ALP: 315 U/l + Most appropriate investigation to confirm the diagnosis >> MRCP (Dx: Primary sclerosing Cholangitis)
🔵 78 yrs known End stage Small cell lung Ca pt now admitted with severe agitation following 300 mg hemoptysis + On exam: Crackles and wheeze on auscultation + Most appropriate way to manage this pt >> Midazolum.
★ Midazooum a Benzodiazepine that can be delivered subcutaneously, is the intervention of choice for agitation in the terminally ill pt
🔵 28 yrs man presented with pain in his left ear and noticed pus-like discharge following return from West Indies + On exam: Erythema and edema in the ear canal on exam + Most appropriate next step in management’s complaints >> Ciprofloxacin/Dexamethasone eardrops. (Dx: Otitis Media)
🔵 71 yrs known Multiple myeloma pt on a steroid-based regimen now presented with nausea vomiting and an episode of fall on Lt shoulder + investigation shows: Na+: 122 mmol/l, K+: 5.2 mmol/l + Most appropriate next intervention >> Hydrocortisone IV (Dx: Steroid-induced Adrenal crisis)
🔵 74 yrs pt known to have Atrial fibrillation on Apixaban now presented with intermittent confusion and drowsy and seems ignoring his Left side + CT scan of brain shows: Concave-Convex shape bleeding + Most likely cause of pt’s symptoms >> Subdural hematoma
🔵 75 yrs old man presented with recurrent headache, and lower limb claudication + On exam: BP: 156/95 mmHg, petechia and purpura on his body, acrocyanosis affecting his fingers and left toes, Hepatosplenomegaly + Multiple peripheral LN + Most appropriate intervention >> Dexamethasone, Rituximab and cyclophosphamide. (DX: Waldenstrom macroglobulinemia with hyperviscosity syndrome)
🔵 56 yrs known diabetic pt presented with persistent lethargy + On exam: BP: 100/60 mmHg, Pigmented skin and armpit + Investigation shows: Na+: 128 mmHg, K+: 5.1 mmol/l + Most appropriate next investigation >> Short synacthen test (DX: Addison’s disease)
🔵 64 yrs man presented with lower limb discoloration following angiography of the abdominal aorta, renal arteries, and lower limb vessels 72 hours before + Most likely cause of Pt’s symptoms >> Cholesterol embolism.
🔵 Known 78 yrs Alzheimer’s disease pt presented with UTI + Multidisciplinary team recommended him place to a Residential home, but he refused to go there + Most appropriate next step >> Arrange a mental capacity assessment
🔵 Best way to reduce pt’s risk of post lumbar puncture headache >> Atraumatic lumbar puncture needle.
🔵 42 yrs man presented with palpitation + On exam: No Past medical history, no weight loss + investigation shows: TSH is normal, ECG shows: 2500 premature ventricular ectopics in 24 hours + Most appropriate intervention >> Reassurance
🔵 82 yrs known heart failure pt on digoxin now presented with nausea, vomiting, and confusion for 24 hours + Recently his dose of frusemide is increased due to SOB + On exam: BP: 90/50 mmHg, HR: 28 bpm + Most appropriate intervention >> Digoxin immune Fab Dx: Digoxin toxicity due to recently increased dose of frusemide)
🔵 38 yrs old man presented with headache, confusion, neck stiffness, and Lt sided 7th Cranial nerve palsy following a recent holiday walk in Austria + Most likely cause of pt’s symptoms >> Neuroborreliosis
🔵 45 yr old man was brought to ED with acute hepatitis against a background of chronic alcoholism + On exam: Rt upper quadrant tenderness + investigation shows: raised Liver enzyme and INR: 6.6 + Most strongly related to poor outcome >> INR 6.6
🔵 45 yrs man presented with pain and stiffness affecting his Rt knee + On exploration: Pt is diabetic and Erectile dysfunction + Most likely cause of pt’s symptoms >> Hemochromatosis
🔵 45 yrs pt presented with progressive SOB and dry cough + On exam: Uveitis is present, Inspiratory fine crepitation throughout both lung fields + Investigation shows: High Ca++, CXR: Bilateral Hilar lymphadenopathy, patchy shadowing throughout both lung fields + Most appropriate intervention >> Prednisolone (Dx: Sarcoidosis)
🔵 71 yrs man known to have Atrial fibrillation on Apixaban now presented to the TIA clinic with H/O 2 episodes of Transient visual loss affecting his Rt eye + On exam: HR: 130 bpm, irregular, BP: 185/100 mmHg + Most appropriate next step in pt’s management >> Bisoprolol to control pt’s heart rate
🔵 35 yrs woman presented with primary amenorrhea + On exam: She is cm tall, with scanty pubic and axillary hair + Most useful investigation >> Karyotyping (Dx: Androgen insensitivity syndrome)
🔵 53 yrs African American woman presented with chronic renal impairment and poorly controlled HTN despite taking Angiotensin converting enzyme+ Investigation shows: Creatinine: 132 mmol/l, CT abdomen: Bilateral fibromuscular dysplasia of renal arteries + Most likely cause of pt’s Hypertension >> Renovascular disease (Renal artery stenosis)
🔵 19 yrs woman presented with the inability to pass urine due to pain following return from Spain + On exam: Multiple small genital ulcers + Moat appropriate intervention >> Valaciclovir (Dx: Genital herpes)
★ Tx of genital herpes: Valaciclovir 500 mg twice daily for 5 days.
🔵 78 yrs known CLL pt on Fludarabine-based chemotherapy now presented with fatigue + On investigation shows: Hb%: 68gm/l + Most likely cause of pt’s anemia in this case >> Autoimmune Hemolytic anemia
🔵 25 yrs woman presented in the dermatology clinic with a rapidly enlarging nodular lesion on her left cheek + On exploration: It has changed in size over the next 8 weeks + Most likely dx >> Nodular melanoma
🔵 19 yrs known T1 DM pt admitted 28 hrs ago with the feature of Diabetic Ketoacidosis + investigation shows: All parameters are normal except Raised Chloride level + Most likely cause of raised Cl- concentration see. Here >> Plasma volume expansion
★ Plasma volume expansion is thought to be the primary cause of hyperchloremic metabolic acidosis during the recovery period of post-DKA
🔵 18 yrs lady presented with low mood and a resting tremor more marked on the left side than on the Rt + Investigation shows: Raised Liver Enzyme level + Most useful next investigation >> Caeruloplasmin (Dx: Wilson disease)
🔵 26 yrs known Schizophrenic pt admitted to ED after having swallowed several 5-P coins and a button of battery used to power a watch + Which situations identified on an x-ray require urgent endoscopy >> Battery in the esophagus
🔵 71 yrs known HTN and DM pt presented with SOB and severe cough + On exam: Rt basal crackles, Oxygen saturation is 91% on 6 liters oxygen via a face mask + Investigation shows: COVID-19 Is strongly positive + Which agent is likely to have on pt’s outcome >> Dexamethasone
★ Dexamethasone has been proven to improve the outcome of COVID-19.
🔵 64 yrs known DM and IHD pt came for follow up after a month of Percutaneous coronary intervention for anterior myocardial infarction + On investigation shows: all vitals are normal, no ankle swelling, LVEF: 28% + Clinical feature is most likely to impact on 6 months survival >> LVEF 28%.
🔵 63 yrs End stage renal disease pt presented with unwell following commencing first session of hemodialysis session + On exam: Pt is confused, headache, nausea and vomiting, and drowsiness + Most appropriate next step >> Sodium remodeling (Dx: Dialysis disequilibrium syndrome)
★ Sodium Remodeling is a feature on dialysis machines that allows manipulation of the sodium on the dialysates.
🔵 78 yrs known Alzheimer’s disease pt now presented with deterioration of his memory + According to his wife: he is aggressive and believes people are trying to poison him + Most appropriate intervention >> Risperidone
🔵 45 yrs female presents with fatigue, itching, and a Yellowish deposit in their upper eyelid + Investigations show that anti-mitochondrial ab is positive + Most likely dx >> Primary biliary cholangitis
🔵 A 25 yrs old woman was brought to ED following an overdose of 50×75 mg amitriptyline tablet + On exam: GCS: 6 and intubated, BP: 90/50 mmhG, ECG: QRS duration 150 ms + Most appropriate intervention >> Sodium Bicarbonate
★ NaHCO3 reduces the chance of seizure and ventricular arrhythmia in a pt with amitriptyline overdose.
🔵 45 yrs old woman with Known H/O asthma presented with palpitation and symptoms of pre-syncope + BP is normal, HR: 130 bpm, ECG: Atrial fibrillation + Most appropriate way to treat this pt >> Verapamil
🔵 32 yrs woman was brought to ED with the features of psychosis + She believes she is pregnant with the son of God + On exam: developed ataxia, writhing movement of her limbs + Investigation shows: Hb%: low, USG of the abdomen: Left ovarian mass + Autoantibody is most likely to be found in this pt >> N-Methyl-D-Aspertate.
🔵 59 yrs known IHD and T2 DM pt presented with uncontrolled DM despite taking metformin 1 gm twice daily, glicazide 80 mg twice daily, dapagliflozin 10 mg daily for glucose + Investigation shows: HbA1C: 62 mmol/mol, BMI: 30 + Most appropriate next step >> Liraglutide.
🔵 39 years old man presented with acute onset of pain affecting Rt shoulder + On exploration: No H/O trauma, pain is sharp and throbbing + On exam: Rt-sided winging of scapula, hyperaesthesia, and pain in the shoulder and lateral arm pain + Most likely underlying cause of pt’s symptoms >> Brachial Neuritis.
★ Brachial neuritis is not caused by trauma. it is related to exercise or acute trauma
★ Tx is: Physiotherapy to maintain strength and movement of the shoulder and analgesia are the mainstay of therapy
🔵 32 yrs known HIV pt presented with worsening sob, palpitation + On exam: Bibasal crackles, pittting edema + ECHO shows: Dialetd cardiomyopathy, EF: 28%, CD4 Count: 55 K + Most likely cause of pt’s symptoms >> HIV associated cardiomyopathy
🔵 43 yrs known Motor neuron disease pt was brought to ED by his wife with complaints of difficulty in breathing at night time and night time snoring + His FVC is 65% predicted + Most appropriate next in management >> Non-Invasive ventilation
🔵 27 yrs old woman presented with difficulty in conceiving a child + On exploration: difficulty in sexual intercourse due to vaginal dryness and low libido, some milk leakage on breast exam+ investigation show: Low FSH and LH, high prolactin, MRI brain: 4 mm pituitary tumor + Most appropriate intervention >> Cabergoline (Pituitary prolactinoma)
🔵 48 yrs known idiopathic membranous glomerulonephritis pt now presented with sudden onset flank pain on Lt side + On exam: Lt flank tenderness and pitting edema on both lower limb + blood test: Creatinine: 235 mg/dl + urinalysis shows: (Protein 3+, Blood 1+) + Most appropriate intervention >> Delteparin (Dx: Renal vein Thrombosis)
★ Cloting factor Anti-thrombin 3 is lost in nephrotic syndrome resulting in an increased chance of venous thrombosis.
🔵 32 yrs old woman was admitted with ascending weakness + On exam: Crackles at both bases consistent with atelectasis, diminished reflexes, and muscle power + Investigation shows: FVC is reduced, CXR: Atelectasis at both lung bases + Most appropriate next step >> Elective intubation (Dx: Guillain Barre syndrome)
🔵 45 yrs man presented with worsening arthritis affecting his both hands + On exam: psoriasis affecting his scalp and elbows + Exam Reveals: Nail pitting and distal interphalangeal joint arthritis + Most appropriate next step in pt’s management >> Methotrexate (Dx: Psoriatic arthritis)
🔵 72 yrs known Smoker pt presented in the Rheumatology clinic following a Lt Colle’s fracture + She was recommended to start monthly bisphosphonate + Most important investigation before starting monthly bisphosphonate therapy >> Dental examination.
★ Poor dental hygiene is a recognized risk factor for osteonecrosis of Jaw.
🔵 32 yr woman presented with H/O recurrent hemoptysis, SOB, night sweat, and anorexia + On exploration: Passing tea-colored urine, On auscultation: Coarse crackles at both lung fields + Investigation shows: Creatinine: 233 mg/dl + Most appropriate intervention >> Methylprednisone and Rituximab (Dx: Wegener Granulomatosis)
🔵 18 yrs old man presented with difficulty in night vision for 2-3 yrs and was noted to have poor peripheral vision + Ophthalmoscopy shows: Retinal pigment abnormality affecting both eyes with a bony spicules appearance + Most likely cause of pt’s symptoms >> Retinitis pigmentosa
🔵 21 yrs pt admitted to ED following severe SOB and Rt-sided pleuritic chest pain + On exam: Absent breath sound on Rt side, Oxygen saturation: 88% on 6 liters Oxygen, CXR shows: Rt-sided large pneumothorax + Most appropriate next step intervention >> Chest drain.
🔵 75 yrs pt with known Colon Cancer metastasis to lung presented with small Volume hemoptysis + On exam: BP:90/60 mmHg, Coarse crackles on auscultation more marked on the Rt than Lt, the abdomen is fully distended + Investigation shows: Low Hb%, low platelet, high Creatinine + CXR: Multiple metastasis patchy shadowing + Most appropriate next step >> Palliative care referral.
🔵 An 18-year-old man was referred to an ophthalmology department due to an abnormal photograph + exploration: he felt his eyes have not been very good over the past few months + Cause of pt’s visual field loss >> Progressive retinal photoreceptor degeneration.
🔵 62 yrs known chronic kidney disease pt presented with acutely swollen and painful rt great toe + On exam: BP:142/82 mmHg, + Investigation shows: Creatinine: 293 micromol/l, Estimated Glomerular filtration rate (eGFR): 9 ml/min/1.73 m2 + Most appropriate intervention >> Prednisolone. (Dx: Acute gout in End stage renal disease pt)
🔵 67 yrs known COPD and smoker pt was brought to ED with complaints of abnormal behavior, increasing drowsiness, short-term memory and emotional liability + Investigation shows: Creatinjne:143 mg/dl, CXR: Lt hilar mass, Contrast MRI of brain; Cortical thickening with increased T2 intensity affecting the mesial temporal lobes and limbic system + Autoantibody is most likely to be found in association with the pt’s symptoms >> Hu (Dx: Limbic encephalitis as a paraneoplastic feature of underlying small cell Lung Ca)
🔵 71 yrs woman presented with chronic pain affecting the pelvis and Rt Hip + On exam: Severe limitations of Rt Hip of flexion and external rotation + Investigation shows: Alkaline phosphatase: 395 IU/l + Most likely cause of pt’s Hip pain >> Paget’s disease.
🔵 53 yrs woman presented with hemoptysis, sinusitis, lethargy, and night sweats + On exam: ™ is high, BP: 155/95 mmHg, inspiratory fine crackles of chest + Investigation shows: Creatinine: 397 micrommol/l, Urinalysis show: (Blood 3+, Protein 2+) + Most appropriate initial intervention >> Methylprednisolone and cyclophosphamide. (Dx: Wegenr granulomatosis)
🔵 28 yrs old man presented with worsening SOB and a productive cough of blood-stained sputum + Investigation shows: Coarse crackles over both lung fields + CXR: Patchy shadowing throughout both lung fields + Most appropriate intervention >> Itraconazole (Dx: Pulmonary histoplasmosis)
🔵 19 yrs pt was admitted with florid hallucination + Shortly after giving IM haloperidol he developed neck pain, spasm in jaw, and stopped looking to the Left + Moat appropriate intervention >> Diphenhydramine (Dx: Haloperidol induced Acute dystonia)
🔵 Known Small cell lung Ca pt presented with worsening proximal myopathy + On exam: Short-term improvement in muscle strength with recurrent activity + Most effective intervention >> 3, 4-diaminopyridine (Dx: Lambert-Eaton myasthenic syndrome)
🔵 45 yrs pt presented with SOB and cough + On exam: Inspirattorg crackles at both bases + Investigation : CXR: Bilateral basal consolidation, Bronchoalveolar lavage: Eosinophilic predominant cell + Most appropriate intervention >> prednisolone (Dx: Eosinophilic Pneumonia)
🔵 42 yrs woman presented with Raynauds phenomenon despite taking nifedipine and sildenafil + On exam: BP: 150/72 mmHg, Fine inspiratory crackles + Investigation shows: ECHO: Rt ventricular hypertrophy + Most appropriate wag to treat pt’s Raynaud phenomenon >> Bosentan.
★ Bosentan is an endothelin receptor antagonist
🔵 48 yrs old man was admitted into the ICU following a Road traffic accident + on exploration: he signed a donor card + Most appropriate confirmatory tests for brainstem death >> Apnoea testing.
★ Apnoea testing evaluates the functioning of the respiratory centers in the ventrolateral medulla oblongata.
🔵 54 yrs woman presented with lethargy, nausea, and vomiting + On exploration: Has osteoarthritis for which taking paracetamol and intermittent ibuprofen + Investigation shows: High K+: 6.5 mmol/l, Creatinine: 321 mg/dl, CT abdomen: Bilateral ureteric obstruction, retroperitoneal fibrosis + Most appropriate next step >> Bilateral nephrostomy tube insertion
🔵 72 yrs man was brought to ED by a social worker + On exploration: he had hoarded many years of newspaper, empty food cans, and other objects in this house + On exam: he was dirty and unkempt + Most appropriate next initial intervention >> Cognitive behavior therapy (Dx: Diogenes syndrome)
🔵 A 56 yrs pt with known COPD presented with sudden pain on Lt heel and was unable to bear weight + On exploration: he was taking: amlodipine, frusemide, Prednisolone, levofloxacin + On exam: Unable to stand on great toe + Medication is most likely to be responsible for this presentation >> Levofloxacin
★ Levofloxacin can cause >> Achilles tendinitis
🔵A 68 yrs woman was referred to Cardiothoracic surgeons for lung volume reduction surgery + FEV1 is 1.7 liters + CT scan: Predominantly upper lobe emphysema + Which feature has the biggest effect on the outcome of surgery in this pt >> Predominantly upper lobe emphysema.
🔵 42 yrs pt presented with weight gain + on exam: he gained 10 kg, developed abdominal striae + High dose Dexamethasone suppression test: unable to suppress morning cortisol concentration + Most likely cause of pt’s symptoms >> Cushing Disease
🔵 45 yrs pt with known Colon Ca on chemotherapy presented with fever and sweating for 24 hours + On exam: ™ is high + investigation: Leukopenia, anemia, high CRP + Most appropriate next intervention >> Piperacillin-Tazobactum (Dx: Neutropenic Sepsis)
