The featured case rotates weekly. All cases stay available below, so you can try any of them at any time.
Are these real patients?
No. They are short fictional teaching scenarios built around the points in the free one-pagers. They are not real patient records.
Can I use them to manage a real patient?
No. They are for revision. Always follow your hospital protocol, current guidelines and senior advice.
Hyperkalaemia
A 58-year-old man with end-stage kidney disease missed his last dialysis session. He is weak. The monitor shows peaked T waves and a widening QRS. Potassium is 7.2 mEq/L.
What is the most important FIRST step?
Treat the heart first. IV calcium gluconate stabilises the myocardial membrane but does not lower potassium. Then shift potassium with insulin and dextrose or salbutamol, and remove it (dialysis in renal failure). Repeat the ECG.
A 45-year-old woman on long-term steroids stopped them a week ago. She now has vomiting, collapse and a blood pressure of 70/40. Sodium is 124, potassium 5.9 and capillary glucose 52 mg/dL.
What should you do immediately?
Think adrenal crisis in shock that does not respond to initial treatment. Give hydrocortisone 100 mg IV stat with aggressive IV fluids, correct hypoglycaemia and find the trigger. Do not wait for cortisol.
A 24-year-old woman at 36 weeks has just had a generalised seizure. Blood pressure is 170/112 mmHg. She is now drowsy and breathing.
After airway and positioning, which drug is first-line?
Stabilise the mother first: airway, oxygen, left lateral position and IV access. Magnesium sulfate is first-line for seizures and prevention. Control severe BP gradually. Delivery is the definitive treatment. Watch for magnesium toxicity: reflexes, respiratory rate and urine output.
Ten minutes after delivery a woman is bleeding heavily. The uterus feels soft and boggy. Pulse is 120 and she feels dizzy.
What is the most appropriate immediate action?
Treat first and investigate later. Call for help, ABC, uterine massage, empty the bladder and give oxytocin. Add other uterotonics and tranexamic acid (within 3 hours of birth) if bleeding continues, and escalate early.
A 30-year-old man on an SSRI was started on tramadol yesterday. He is agitated and sweating, with a tremor, inducible ankle clonus, hyperreflexia and a temperature of 39°C.
Which is the best initial management?
Stop all serotonergic medicines. Benzodiazepines are the cornerstone, with external cooling and IV fluids. Paracetamol is not effective because the fever is from muscle activity. Clonus with hyperreflexia is the most specific sign.
A 38-year-old woman who stopped her antithyroid medicine has a temperature of 40°C, a heart rate of 150, agitation and vomiting. Heart failure has been looked for and is not obvious.
Which statement about treatment is correct?
Treat first, confirm later. Control the heart with a beta-blocker where appropriate, block hormone production (PTU), and give iodine only after the antithyroid drug. Hydrocortisone also reduces T4 to T3 conversion.
A 65-year-old man with pneumonia has a blood pressure of 80/50, a heart rate of 120 and a lactate of 5 mmol/L.
Which combination reflects the first hour of care?
Think sepsis early. Take cultures if it does not delay antibiotics, give 30 mL/kg crystalloid for hypotension or high lactate, give antibiotics within one hour and start norepinephrine if hypotension persists. Control the source.
A 70-year-old woman with type 2 diabetes has been unwell for days. She is confused and dehydrated. Glucose is above 900 mg/dL, pH is 7.38 and ketones are minimal.
What is the correct order of priorities?
Fluids are the first priority in HHS (profound dehydration). Check potassium before insulin and replace it if low. Do not give bicarbonate since pH is above 7.30. Look for and treat the trigger.
An 78-year-old man with diabetes is found confused and sweating. He takes glimepiride. He cannot swallow safely.
What is the best next step?
Check capillary glucose in any altered consciousness. If glucose is low and he cannot swallow, give IV dextrose (or IM glucagon), recheck and follow with a longer-acting carbohydrate once safe. Sulfonylureas can cause recurrent hypoglycaemia, so observe.