Blog

Mr. Sputami, a 59 year-old divorced salesman, comes to your office for a routine exam. He states that he has had “no big problems”, but seems to be getting tired lately. “It’s sometimes all I can do to get home from work and lie down.” He admits to smoking one pack of cigarettes daily since age 18 years. Denies a history of asthma, CAD, or other pulmonary or cardiac illnesses. States that he was advised to quit smoking about three years ago when he had a period of “trouble breathing”. He has been unable to quit smoking and has had no breathing problems since. He further states “I cough stuff up every now and then since I had a bad cold a year ago, but I’m really okay.” On further questioning, it seems he has a productive cough almost daily, worse in the morning. On physical exam, Mr. S. is a middle-aged male who appears his stated age. His vital signs are: Temp 98.4, pulse 88, respirations 24. He expectorates a small amount of creamy white secretions while you are examining him. His pharynx is not inflamed, nor is there any lymphadenopathy. Auscultation of Mr. S’s lungs reveals scattered crackles and wheezes throughout, with generalized decreased breath sounds. No increased fremitus, AP:lat ratio = 1:1, no tenderness. Peak Flow decreased. The remainder of his exam is normal. Based on history and physical findings, which of the following is the most likely diagnosis?

What advice should be provided to this patient based on their home blood pressure results?

The patient later decides that she would like to start on regular contraception. After discussing the available options she chooses to start a combined oral contraceptive Mercilon (ethinylestradiol 20 micrograms / desogestrel 150 micrograms). She is on day 8 of her menstrual cycle.   How long will it take for Mercilon to become fully effective, so she can safely stop using condoms?

Utilising the excerpt provided below, what perioperative adjustment should be made to this patient’s diabetes medication before surgery?   Day prior to surgery Morning of surgery a. Omit all diabetic medication Omit all diabetic medication b. Take all diabetic medication as normal Omit all diabetic medication c. Take all diabetic medication as normal Take metformin as normal, omit dapagliflozin and gliclazide d. Take metformin and gliclazide as normal. Omit dapagliflozin Omit all diabetic medication e. Take metformin and gliclazide as normal. Omit dapagliflozin Take metformin as normal, omit dapagliflozin and gliclazide  

For the following 3 questions, you may refer to the following resource: Chlamydia 2015 | BASHH

Mr. J. is a 70 year old retired accountant who was discharged from the hospital three months ago following treatment for a myocardial infarction. He was able to resume light activity at home. Approximately one month ago, he began to experience occasional exertional dyspnea and fatigue. Presently, he feels tired and short of breath while climbing one flight of stairs. He is able to work in his garden for only 15-20 minutes before becoming tired and short of breath. He sleeps comfortably on two pillows. He denies chest pain, cough, anorexia, nausea, or edema.His physical exam reveals that Mr. J. appears anxious. Vital signs: BP 107/70, P 94 and Reg., Resp 22, wt 150, a gain of 6 pounds from the previous month. On examination of his eyes, his conjunctiva are clear, sclera white and lenses moderately opaque. His fundi are not visualized. With Mr. J. resting at a 45 degree angle, his neck veins are at the level of the sternal angle and do not rise upon deep palpation of the liver. His breath sounds are decreased in both bases with crackles heard bilaterally. His apical impulse is accentuated and visible at 15 cm lateral to his mid-sternal line. On auscultation, S1 and S2 are distant with an extra low-pitched heart sound early in diastole heard at the apex. Mr. J’s abdomen is non-tender. There are no palpable organs or masses. His peripheral pulses are all 2+ and there is 1+ ankle edema.Exertional dyspnea and fatigue may be related to prolonged inactivity and weight gain, but with Mr. J’s history and physical findings, you should be especially suspicious of:

Which of the following lifestyle changes is most strongly recommended before conception?

An 18 yr old male comes to the ER with c/o sudden onset of SOB and chest pain. He denies injury, illness or cough. Percussion hyperresonant, fremitus absent, breath sounds NOT audible over Right chest, RR 32. The Left chest is normal. The most likely diagnosis is:

In which of the following population groups should Mounjaro be used with caution?

Patients prescribed which of the following medications should be advised to report fatigue, a sore red tongue and cognitive changes.