Alternative drug of Fentanyl lozenges 200mcg

A 73-year-old woman presented to the emergency department with a painful umbilical nodule that had been enlarging over the past 4 months. Physical examination revealed a painful and firm erythematous umbilical nodule measuring 2 cm in its largest diameter. What is the likely diagnosis? A) Keloid B) Umbilical hernia C) Pyoderma gangrenosum D) Pyogenic granuloma F) Sister Mary Joseph's nodule

A 32-year-old man presented to the emergency department with difficulty swallowing oral secretions and the feeling that food was stuck in his throat after he ate a pizza roll. Upper endoscopy revealed the following image after food impaction was removed. This finding is associated with what underlying diagnosis? A) Gastroesophageal reflux disease B) Crohn's disease C) Barrett's esophagus D) Eosinophilic esophagitis E) Plummer Vinson syndrome

Case Challenge of the day: A previously healthy 50 y/o male presented with a 2-week history of malaise, anorexia and worsening abdominal pain, which progressed to nausea, vomiting and scleral icterus. He initially attributed his symptoms to an influenza-like syndrome; however, he became alarmed when he developed dark urine and generalized jaundice. The patient had no known personal or family history of liver disease. No history of any medications. He denied any changes in his diet or use of alcohol, tobacco or illicit drugs, but endorsed drinking 4–5 energy drinks daily for 3 weeks prior to presentation. . He did get a tattoo in his 20s, but denied any transfusions of blood products or high-risk sexual behavior. On physical examination, the patient had normal vital signs, scleral icterus and jaundice. Abdominal examination was remarkable for right upper quadrant (RUQ) tenderness, but there was no ascites, asterixis, spider angiomata or other signs of chronic liver disease. Laboratory studies revealed normal renal function. Rest you can see in the image. What do you think is the diagnosis and management of this case? Reference: www.ncbi.nlm.nih.gov

A 58 year old male, non-smoker, asthmatic patient was referred with 3 weeks history of breathlessness, wheezing, and dry cough. He had a history of acute severe asthma many years ago. However, he had not required ventilatory support during that period. Since then, he had self-medicating intermittently with oral salbutamol and theophylline only. On examination, the patient had dyspnoea at rest and tachycardia. Oxygen saturation was 90% on room air. Respiratory examination revealed bilateral polyphonic rhonchi; otherwise, he was normal. Arterial blood gas analysis revealed hypoxemia (PaO2: 54 mmHg) with respiratory alkalosis (pH: 7.43, PaCO2: 32.3 mmHg and Bicarbonate: 20 mEq/l). Let's discuss the case on today's World Asthma Day

#ItsTime A 37 y/o/m patient was admitted with a history of perianal discharge and ulceration for the last 4 months. According to his medical history, he was treated for a perianal abscess which was incised and drained 1 year ago, yet, despite the initial healing, it recurred 2 months later. No lymphadenopathy was found on palpation; in addition abdominal examination revealed a generalized tenderness. The perianal region examination showed large bilateral infected ulcerations followed by pus. The digital rectal one revealed no pathological findings except a slight sphincter hypotonia. Anoscopy was normal and no fistulas were noted. The rectosigmoidoscopy showed no abnormalities as well. Please help if its a case of TB?