IM Emer

A 33-year-old woman attends her six-month follow-up appointment for headache. They are migrainous in nature but whereas she used to have them every few months, over the last three months she has experienced a chronic daily headache which varies in location and can be anywhere from 3-7 /10 severity. Her last migraine with aura was two months ago. She takes cocodamol qds and ibuprofen tds. What is the best medical management?

A 23-year-old woman complains that her right leg has become progressively stiff and clumsy over the last couple of weeks. She is worried as she has not been able to go to work for the last 4 days. On examination, tone is increased and there is a catch at the knee. She has six beats of clonus and an upgoing plantar. Power is reduced to 3-4/5 in the right leg flexors. There is no sensory involvement and the rest of the neurological exam is normal other than a pale disc on opthalmoscopy. On further questioning, she admits that she has had two episodes of blurred vision in her right eye in the last two years. Each lasted a couple of weeks from which she fully recovered. What is the most appropriate initial treatment?

A 17-year-old girl is brought into accident and emergency with generalized tonic- clonic seizure. Her mother had found her fitting in her bedroom about 20 minutes ago. The ambulance crew handover state that her sats are 96 per cent on 15 L of oxygen and they have given her two doses of rectal diazepam but she has not stopped fitting. What is the most appropriate management?

A 62-year-old woman with metastatic breast cancer, including bone metastases, presents to accident and emergency with sudden onset back pain and difficulty walking. An urgent MRI of the spine confirms cord compression at the level of Ll-L2. What is the most appropriate initial management?

A 48-year-old woman with a recent diagnosis of metastatic cancer of unknown primary, including metastasis to the sacral and thoracic spine, is currently being treated for lower back pain with regular paracetamol, diclofenac and oral morphine solution. She is receiving additional oral morphine solution rescue doses for her breakthrough pain. On review of her drug chart, she has received 60 mg of oral morphine solution over the past 24 hours. Which of the following is the most appropriate escalation for this patient's pain management?

A 19-year-old medical student presents to his GP during fresher's fortnight. He is complaining of neck stiffness, headache and sensitivity to light. On examination, a non-blanching, petechial rash is observed on the trunk. What is the most appropriate immediate management?

A 28-year-old woman is rushed to accident and emergency in a confused state. Her partner reports seeing the patient vomiting and breathing very rapidly before falling ill, at which point he called the ambulance. Empty aspirin packets were found close to the patient, the partner estimates it has been approximately 45 minutes since the patient may have ingested the pills. The most appropriate first- line management would be: