Patient PU (female, 55 years old, weight 80 kg) has become severely unwell with a skin problem, described in her notes as ‘detachment of around 5% of Body Surface Area with widespread erythematous macules’. This was preceded by an upper respiratory tract infection with a fever and headache, before the lesions suddenly developed. Which is the MOST LIKELY diagnosis?

Patient PO (male, 23 years old, weight 70 kg) is in hospital being treated for poisoning. They are being correctly treated according to guidelines and administered activated charcoal to enhance the elimination of the overdosed substance. Which drug is MOST LIKELY to have been ingested?

Patient GS (male, 41 years old, 82 kg) is being assessed in primary care by the nurse practitioner. They have sinusitis which is causing pain, rated 7/10. Past medical history: Gastro-oesophageal reflux disease Medication history: Lansoprazole 30 mg daily Adverse drug reactions to tramadol and codeine. Caused extreme nausea and stomach cramps. Which medication would be MOST APPROPRIATE?

Patient UE (58 years old, weight 89 kg) presents to the walk-in centre complaining of shortness of breath and a sharp pain when breathing in, plus feeling generally ‘awful’. On examination she is pale, her oxygen saturations are 88% on air, her heart rate is 112 beats per minute, blood pressure 109/78 mmHg, temperature 37°C. She denies any recent travel, she does not smoke nor drink alcohol. Her drug history is: Elleste-Solo tablets 1 mg daily which she takes for symptoms of the menopause. She has no other significant medical history. A two-level PE Wells score is calculated. From the information provided, what course of action would seem MOST APPROPRIATE?

Patient JS (71 years old, weight 93 kg) has presented with a painful, swollen joint affecting the big toe on his right foot. It is hot to the touch and red. Past medical history Hypertension Hypercholesterolaemia Heart failure Chronic Kidney Disease Stage 3a (eGFR 55 ml/min/1.73m2) Medication history Atorvastatin 20 mg once daily Lisinopril 20 mg once daily Furosemide 80 mg in the morning, 40 mg lunchtime (increased 2 weeks ago) Paracetamol 1 g four times daily Multivitamin ONE tablet once daily (buys over the counter) no known drug allergies A diagnosis of an acute flare of gout is made. What is the MOST LIKELY cause of this acute flare of gout in Patient JS?

Patient KW (female, 35 years old, 74 kg) is in hospital with an episode of diverticulitis. She rates her current pain as 4/10 and would like to take something to help. Past medical history: Diverticulosis Depression Medication history: Fluoxetine 20 mg once daily Allergy to ibuprofen, caused lip swelling and wheeze What would be MOST APPROPRIATE to offer in the FIRST instance?

Patient YP (75 years old, weight 68 kg) has type 1 diabetes mellitus and mild dementia. She was discharged from hospital three days ago following treatment of a urinary tract infection. She lives alone and usually has district nurses administering insulin. Upon investigation it is revealed that they were not informed of Patient YP’s discharge and therefore have not been visiting to administer her insulin. Today she is readmitted to hospital as her son has found her to be unwell. She is drowsy, more confused than usual, vomiting and her breath has a smell of ketones. She is diagnosed as having diabetic ketoacidosis (DKA). Which treatment should be started in the FIRST instance?

Eliza Corp., an American software development company, outsources its support operations to Madan, an African nation, because it has found that Madan has a large cohort of English-speaking college graduates who are ready to work for one-third the pay of comparable American workers. Which of the following is most likely to have influenced Eliza Corp.’s decision to outsource its support operations to Madan?

Patient AN (female, 62 years old, weight 70 kg) has been diagnosed with Stevens-Johnson syndrome-toxic epidermal necrolysis overlap. Past medical history: asthma gout hypothyroidism Medication history: allopurinol 300 mg once daily Forceval® one capsule once daily levothyroxine 50 micrograms once daily loratadine 10 mg once daily salbutamol inhaler 100 micrograms/puff two puffs when required Which medication would be the MOST LIKELY to suspect as a possible cause?

Which set of blood results would be MOST LIKELY to represent Patient YP’s (question 5) results on arrival in Accident and Emergency?