Signs Symptoms

A 58-year-old man presents to the emergency department with two episodes of haematemesis and dark, tarry stools over the past 6 hours. He has a history of osteoarthritis for which he takes regular ibuprofen, and admits to drinking approximately 40 g of alcohol daily. On arrival he appears pale and diaphoretic, with a blood pressure of 92/58 mmHg, heart rate 118 bpm, respiratory rate 22/min, and SpO2 96% on room air. Abdominal examination reveals mild epigastric tenderness without peritonism, and a digital rectal examination confirms melaena. Two large-bore IV cannulae are inserted and a bedside haemoglobin returns at 78 g/L. What is the most appropriate immediate management for this patient?

A 29-year-old woman who is 7 weeks pregnant by last menstrual period presents to the emergency department with severe pelvic pain. Her serum β-hCG is 7,000 IU/L. Transvaginal ultrasound demonstrates a small centrally located fluid collection within the endometrial cavity (a pseudosac), with a moderate amount of free fluid in the pelvis. What is the most appropriate next step in management?

A 78-year-old woman is brought to the emergency department by her daughter after three witnessed syncopal episodes over the past two months. Each episode occurred without warning while she was seated, lasted less than a minute, and resolved spontaneously without post-ictal confusion. She has hypertension treated with amlodipine and denies chest pain, palpitations or head strike. Vital signs are BP 128/76 mmHg, HR 58 bpm and regular, RR 16, SpO2 98% on room air, afebrile. Cardiovascular and neurological examinations are unremarkable, and 12-lead ECG shows sinus rhythm with a first-degree AV block. Given the intermittent nature of her symptoms, an implantable loop recorder was inserted. At three-month follow-up, interrogation reveals an asymptomatic sinus pause of 7 seconds recorded overnight, with no corresponding symptoms logged by the patient. What is the most appropriate next step in management?

A 70-year-old man presents to the emergency department with a 6-hour history of passing bright red blood per rectum and several episodes of loose, blood-streaked stool. He has non-valvular atrial fibrillation maintained on long-term warfarin and completed a course of amoxicillin-clavulanate for a chest infection one week ago. He denies haematemesis, melaena or abdominal pain but reports feeling light-headed on standing. On examination he is pale, BP is 100/65 mmHg, HR 108 bpm, RR 18, temperature 36.8°C and SpO2 98% on room air. Abdomen is soft and non-tender; digital rectal examination confirms fresh blood with no melaena. There are no stigmata of chronic liver disease. Investigations reveal haemoglobin 95 g/L, platelets 210 × 10^9/L, INR 8.0 and APTT within normal limits. The most appropriate next step in management is:

A 30-year-old man presents to the emergency department with a 5-day history of pain and swelling of his right knee and left ankle, red gritty eyes, and dysuria with a mucoid urethral discharge. Three weeks earlier he had an episode of bloody diarrhoea while travelling overseas that resolved without treatment. He denies any new sexual partners. On examination he is afebrile with HR 88 bpm and BP 122/76 mmHg. There is a tense effusion of the right knee with reduced range of motion, mild synovitis of the left ankle, bilateral conjunctival injection without discharge, and a few keratotic papules on the soles of both feet. Urinalysis shows pyuria without nitrites, and urethral swab NAAT for Chlamydia trachomatis and Neisseria gonorrhoeae is pending. Which of the following is the most likely diagnosis?

A 2-year-old boy is brought to the emergency department by his parents with a 2-day history of coryza and low-grade fever, followed by the acute onset of a barking cough and hoarse voice overnight. He is alert and interactive, sitting comfortably on his mother's lap. His temperature is 37.8°C, heart rate 128 bpm, respiratory rate 28/min, and SpO2 98% on room air. Examination reveals a hoarse cry and mild inspiratory stridor that is only audible when he becomes upset during examination, with mild suprasternal retractions and slightly diminished air entry bilaterally. There is no drooling, cyanosis or altered conscious state. His Westley croup score is calculated as 3, consistent with mild-moderate croup. Which of the following is the most appropriate management?