Transjugular intrahepatic portosystemic shunt (TIPS) is not useful in ?
A.Ascites
B.Hepatic encephalopathy
C.hepatorenal syndrome
D.variceal heamorrage
A 19 year old after trauma presents with an inability to bring the spoon in front of his mouth to eat. Where is the lesion?
Temporal lobe
Parietal lobe
Occipital lobe
Cerebellum
A 52-year-old man is seen in the hypertension clinic. He was diagnosed around three months ago and started on ramipril. This has been titrated up to 10mg od but his blood pressure remains around 156/92 mmHg. What is the most appopriate next step in management?
Add bendroflumethiazide
Add bisoprolol
Switch ramipril to perindopril
Add amlodipine
Add losartan
You have been asked to review a 52-year-old woman in the emergency department with dyspnoea accompanied by nausea and vomiting. She tells you that she initially attributed this to a flu-like illness but as she found herself becoming increasingly short of breath she was taken to hospital by her concerned husband. Her past medical history is significant for type 2 diabetes mellitus, hypertension and obesity. Her current medications include metformin 1gram bd, canagliflozin 100mg od, ramipril 10mg od and amlodipine 5mg od. On examination she has a respiratory rate of 25 breaths/min, blood pressure 130/67 mmHg, pulse 105 bpm and oxygen saturation of 98% on room air. The only finding you elicit on physical examination is mild tenderness in the epigastric area. Her ECG shows a sinus tachycardia. Routine blood results are shown below:
Hb 167 g/l Na+ 132 mmol/l Bilirubin 22 µmol/l pH 7.14
Platelets 410 * 109/l K+ 5.5 mmol/l ALP 100 u/l PaO2 12 KPa
WBC 11.2 * 109/l Urea 10.4 mmol/l ALT 55 u/l PaCO2 1.9 KPa
Neuts 10.0 * 109/l Creatinine 111 µmol/l γGT 23 u/l HCO3- 11µmol/l
Lymphs 1.1 * 109/l Amylase 321 U/l Albumin 33 g/l Lactate 3.0 mmol/l
Eosin 0.1 * 109/l Cl- 101 mmol/l Urine Ketones 3+ Base Excess -12
What is the most likely diagnosis?
Small bowel obstruction
Metformin induced lactic acidosis
Starvation ketosis
Euglycaemic diabetic ketoacidosis
Pancreatitis
A 62-year-old man with known aortic stenosis who has a valve gradient of 40 mmHg presents to the clinic with worsening tiredness. He currently has no symptoms of heart failure or syncope but is under active follow up for his AS. He currently takes amlodipine 5mg for his associated hypertension. On examination he looks pale, his BP is 155/100 mmHg, his pulse is 80/min and he has an ejection systolic murmur. He is not in cardiac failure.
Investigations; Hb 9.7 g/dl MCV 78 fl WCC 5.4 x 109/L PLT 130 x 109/L Na+ 141 mmol/l K+ 4.7 mmol/l Creatinine 100 μmol/l Upper GI endoscopy normal
Which of the following investigations is most likely to give an accurate diagnosis?
1- Colonoscopy 2- Iron studies 3- Mesenteric angiography 4- Small bowel follow through 5- Serum haptoglobins