SBA Revise 6

Hamid attends as he is feeling feverish and unwell. His observations at triage show a RR 28, SpO2 100%, HR 132, BP 105/70, GCS 15, CBG 12, Temp 38.2. He is normally fit and healthy.

Examination reveals a large abscess on his L posterior back.

Hamid asks you to lance his abscess, so then he can go home.

What is your best course of action?

The emergency buzzer is pulled. On your arrival you notice a patient having a seizure. Their eyelids are closed, and you cannot open them. The seizure stops after 2 minutes, and the patient starts crying. You notice they have bitten their tongue and were incontinent of urine.
Which statement is most accurate?

A 20-year-old man presents with a headache that has been on-going for the past three weeks. He reports that he has vomited on most days. He has photophobia and neck stiffness. In addition, he is febrile and complains of night sweats and weight loss.

He has no other medical history. He moved to the UK four years ago from South East Asia.

What is the most likely cause of this patient’s symptoms?

Trauma Pre-alert for 35-year-old gentleman who sustained injury to head and back after diving into the shallow end of a swimming pool.

HR 85, BP 80/50, RR 18, SaO2 100% on 15L, E3V4M5

A – Patent

B – Air entry equal, no obvious injury

C – No obvious external bleeding, abdomen soft and non tender, no bruising around pelvis, no obvious long bone fractures

D – E3V4M6, PEARL, Laceration to forehead, no signs of base of skull fracture. He has movement to both arms, but no movement or sensation to his lower limbs up to mid chest. When he is catheterised, he has no sensation of tug on catheter.

E – T 36.5, BM 8.7

What is the most appropriate initial treatment for his hypotension?

A 35-year-old male patient presents to the Emergency Department (ED) with a one-week history of shortness of breath and a cough. His blood pressure and heart rate are normal.

Despite appearing comfortable, his oxygen saturation on room air is 69%. He has a history of pulmonary hypertension secondary to congenital hypoventilation syndrome.

A chest radiograph is obtained (figure 1).

Based on the x-ray and information provided, what is the most likely diagnosis?

A 31-year-old woman presents to the Emergency Department (ED) complaining of gradual onset double vision for the past week. When asked to elaborate she shouts – “I see 2 cigarettes when I’m smoking! I keep dropping them!”. She also describes general discomfort around the eye and puffy eyes due to lack of sleep. No other symptoms.

She has no medical or surgical history, takes the oral contraceptive pill and has no allergies.

On examination, you find bilateral oedematous eyelids, conjunctival injection and that she is fidgeting with her hands. She has normal visual acuity but is unable to close her eyes.

Observations: RR 15, SpO2 100% RA, HR 98, BP 145/76, T 37.4.

What is the first question that should be asked regarding this diplopia?

You are the most senior doctor in your Emergency Department (ED).

Three of your patients are now approaching end-of-life care.

The teams involved in their care discuss with you each patient’s suitability for organ donation.

A patient dies in the Emergency Department before they could be transferred to a medical ward.

Which of the following conditions would prevent this patient from being an organ donor?

A 35-year-old male presents to the Emergency Department (ED) with a dog bite to his hand. It happened three hours ago and he washed his hand with soap and water before arriving to the ED.

He takes Apixaban and Bisoprolol for atrial fibrillation.

Which of the following is true with regards to factors increasing the risk of wound infection?

A 26-year-old city-worker presents to your Emergency Department (ED) with a rash as shown in the image above.

Last month he was in close contact with a colleague diagnosed with mpox.

Over the past week he has had muscle aches, fevers and a cough.

Which of the following clinical signs is the most reliable in differentiating mpox (monkeypox) from smallpox and chickenpox?

A 2-year-old girl presents in the Paediatric Emergency Department (ED) at 23:00 hrs. Mother reports the girl has long standing eczema for which she is on Cetraben as regular emollient and topical steroids for flare ups. She is concerned that the rash has got worse suddenly especially over her knees and the child is refusing to weight bear on her left leg. She was also in pain. Otherwise, the child is feeling well.

Her past medical history is insignificant.

There is history of atopy in the family.

On examination, the child appears in pain, but is alert and afebrile.

Widespread dry scaly skin is noted throughout with active inflammatory areas over the flexures – neck, elbows, back of legs and back. She has scattered, uniform punched out vesicles and ulcers in clusters on an erythematous base over the face, especially around the eye, knee and buttock region. Swelling around left knee is also noted.

What is the most likely diagnosis causing the symptoms in the left knee?