A 28-year-old woman is brought to the Emergency Department after being found by her roommate having ingested a quantity of Paraquat and an unknown quantity of benzodiazepines. It is suspected that she took the overdose approximately 4 hours ago.
On examination in the department, her BP is 118/82 mmHg, pulse is 88/min and regular, and she is drowsy due to having taken the benzodiazepines.
What is a crucial step in managing a Paraquat overdose?
A 29-year-old man comes to the clinic for his routine HIV check-up. He was diagnosed with HIV four years ago and has been taking Eviplera (emtricitabine/rilpivirine/tenofovir) regularly. Recently, his GP prescribed him a new medication.
The blood test results are as follows:
Hemoglobin (Hb) – 134 g/l
Platelets – 345 * 109/l
CD4 count – 580 * 109/l (normal range 500-1500)
Viral load – 1480 copies/ml* 109/l
Sodium (Na+) – 136 mmol/l
Potassium (K+) – 4.2 mmol/l
Urea – 6.5 mmol/l
Creatinine – 65 µmol/l
What is the new medication that could explain these results?
A 35-year-old amateur bodybuilder presents to the Hepatology Clinic with abnormal liver function tests. He reports taking various dietary supplements but denies using any prescription medications. On examination, his blood pressure is 140/90 mmHg, and his pulse is 70 bpm and regular. He has significant muscle development and normal pubic and axillary hair, but his testes appear smaller than expected. Laboratory tests show the following results:
– Hemoglobin (Hb): 180 g/l (normal range: 135-175 g/l)
– White cell count (WCC): 7.5 × 109/l (normal range: 4.0-11.0 × 109/l)
– Platelets (PLT): 320 × 109/l (normal range: 150-400 × 109/l)
– Sodium (Na+): 142 mmol/l (normal range: 135-145 mmol/l)
– Potassium (K+): 4.2 mmol/l (normal range: 3.5-5.0 mmol/l)
– Creatinine (Cr): 100 µmol/l (normal range: 50-120 µmol/l)
Which of the following parameters is most likely to be decreased in this patient?
A 67-year-old man is brought in unconscious by ambulance. On arrival to the emergency department, he has a Glasgow Coma Score (GCS) of 5. His airway appears to be obstructed. His daughter arrives shortly after and reports that he may have taken an excessive amount of lorazepam pills. He has a history of regular lorazepam use and also takes sertraline.
His urea and electrolytes are within normal limits, but arterial blood gas results indicate respiratory depression with elevated CO2 and reduced O2 levels.
What is the most appropriate course of action?
A 27-year-old woman presents with recurrent slurring of her speech that worsens as she continues to talk. She has double vision that worsens while reading and subsequently improves with rest, as well as intermittent weakness of the limbs.
During examination, visible ptosis is observed – she explains this also improves with rest. Proximal muscle weakness is evident, with no wasting.
In addition to the suspected neurological diagnosis, she has a fever and a concurrent infection is suspected. The source is being investigated.
Given the likely underlying neurological diagnosis, which antibiotic should be avoided?
As a reviewer, you are examining the necessary drug interaction trials for a new inhaled medication designed to treat chronic obstructive pulmonary disease (COPD) in elderly patients. This medication has both partial beta-agonist and partial anticholinergic activity. Among the list of agents that may require an interaction study, which one has a brief plasma persistence but a significantly longer duration of action?
You participate in a seminar where you analyze information on a novel beta-receptor agonist for managing asthma. Based on your comprehension of agonism and antagonism, which of the subsequent medications is most accurately characterized as a non-competitive antagonist drug?
A 62-year-old man, who has been on the ITU for an extended period due to MRSA septicaemia, a myocardial infarction, and subsequent left ventricular failure, visits the clinic for a check-up. He reports experiencing dizziness and tinnitus, particularly when he turns his head quickly or goes out at night. During the examination, you are able to replicate his dizziness by rapidly moving his head. The rest of the clinical examination is normal. What is the most probable cause of his symptoms?
A 72-year-old male presents as an acute admission at 2 am with confusion and diarrhoea. Little is known of his past medical history except that it is noted on the GP letter that he is receiving treatment for manic depression and hypothyroidism.
Examination reveals that he has a Glasgow coma scale of 14 as he is confused. He is thin, unkempt and dehydrated with a temperature of 37°C. He has a pulse of 82 beats per minute in a regular rhythm and a blood pressure of 112/72 mmHg. He is noted to have a coarse tremor and dysarthric speech.
What investigations would be helpful in the immediate setting?
A 72-year-old woman comes to the ENT Clinic complaining of sensorineural deafness. As part of her medical history review, you note that she has taken aciclovir, amoxicillin, co-amoxiclav, oral furosemide, and received iv erythromycin during a recent hospitalization for a severe lower respiratory tract infection. Which of these medications could be a potential factor in her hearing loss?