This woman has become acutely breathless from a pulmonary emboli. She is hypoxic and, as a reflex to this, is hyperventilating (as evidenced by the low PaCO2). As a result, she has developed an alkalosis. The other options are much …
The answer here is to increase the dose of ICS. The patient is considered to be at step 4 of the BTS guideline which recommends increasing the ICS dose to 800 mcg/day or to consider a trial of Theophylline. Be …
The features described is diagnostic of left sided tension pneumothorax Tension Pneumothorax Presentation – Acute respiratory distress – Hypotension – Raised jugular venous pressure – Tracheal deviation away from the pneumothorax side – Reduced air entry on affected side Management …
The patient is at risk of acquiring a blood-borne viral infection such as hepatitis B, hepatitis C and HIV. The biter is known to be a drug addict, and therefore is at a higher risk of being infected with a …
The fever, headache, vomiting and drowsiness are nonspecific but given there is absent history of symptoms of a urinary tract infection or respiratory infection, we should consider CNS involvement. The key phrase here is also photophobia which makes meningitis the …
There is suspicion of Paget’s disease of the breast/nipple here. These are usually diagnosed by having a simple skin punch biopsy. PAGET DISEASE OF THE BREAST/NIPPLE This is an uncommon breast malignancy with a generally better prognosis thaninfiltrating ductal carcinoma. …
Perioperative management of diabetes is often quite confusing. Below are guIdelines that give you an idea of which medications need to be stopped and when they can be restarted. It is not an exhaustive list and different hospitals have different …
The first hint here is his sex (male) and his occupation (manual worker). In adults, malesex and heavy lifting are risk factors for inguinal hernias Traditionally it is taught that an inguinal hernia will lie above and medially to the …
Anal fissures are caused by constipation and straining. Patients often remember the episode of pain when the tear occurred. The pain is so severe tht they would refuse rectal examinations. The distractor here is anal abscesses and haemorrhoids. Anal abscesses …
Low or simple fistulae like in this stem are usually “laid open” by cutting a small amount of anal skin and muscle to open the tract. Chronic granulation tissue is removed and the tract is left open to allow it …