A 55-year-old man visited the anticoagulation clinic to have his INR monitored. He had experienced an ileo-femoral deep vein thrombosis two months ago after a long-haul flight. He was prescribed warfarin 5 mg daily with a target INR of 2.5. During his visit, he reported the sudden appearance of multiple bruises on his legs without any known cause. His INR was measured at 8.8 (<1.4). What is the appropriate management for his elevated INR?
A 28-year-old medical student has been brought to the Emergency Medical Unit after ingesting an overdose of paracetamol 4 hours ago. You have checked the paracetamol levels, which are above the treatment threshold, and have started administering the appropriate dose of N-acetyl cysteine (NAC). Shortly after starting the infusion, the patient reports experiencing facial flushing and widespread itching. There is no swelling in the mouth or face, and there is no indication of airway obstruction.
What is the best course of action in this situation?
Please evaluate a 24-year-old male patient who was admitted to the hospital yesterday for the treatment of community-acquired pneumonia. He is currently receiving amoxicillin+clavulanate, and he has never been treated with penicillin-based medication before. Apart from paracetamol and codeine for pain relief and metoclopramide for nausea, he is not taking any other medications. However, he has developed a widespread, itchy, erythematous rash after the most recent dose of antibiotics. On examination, his blood pressure and pulse rate are stable, and there is no evidence of bronchospasm or oro-facial swelling. Which antibiotic would be the safest to administer in this scenario?
A 68-year-old male with Parkinson’s disease is being evaluated in the Neurology Clinic. He is currently taking madopar 100/25 QDS and ropinirole M/R 8 mg daily, but experiences problematic ‘off’ periods that vary from day to day. Increasing the dose of madopar previously caused confusion. During the neurological examination, cogwheel rigidity, an asymmetrical resting tremor, and bradykinesia were observed, with the right side being worse. What lifestyle and symptom review may lead to improved motor control?
A 78-year-old man comes to the Emergency Department due to concerns from his wife about his behavior. She reports that he was packing a suitcase because he believed he was on a cruise and needed to go home. The patient was recently prescribed antibiotics for a UTI by his General Practitioner. He has a medical history of benign prostatic hyperplasia, osteoarthritis, hypertension, and gout. During the examination, he appears disoriented and experiences lower abdominal discomfort. Which of the patient’s current medications is most likely contributing to his symptoms?
A 56-year-old woman with multiple chronic conditions presents to the Emergency Department after intentionally overdosing on paracetamol tablets. What medication, when taken long-term, increases the likelihood of complications from paracetamol overdose?
A 67-year-old man presents to the Respiratory Clinic with a 5-month history of intermittent chest tightness and difficulty breathing. He occasionally experiences a dry cough but denies any fever or cold symptoms. His wife reports that he sounds wheezy at times. The patient has a medical history of hypertension, gout, and atrial fibrillation. He does not smoke and has no known allergies. On examination, he has a respiratory rate of 20 breaths/minute and saturations of 94% on room air. Mild bilateral wheeze is heard on auscultation. After conducting normal blood tests and chest X-ray, the Respiratory Consultant suspects that the patient’s symptoms may be drug-induced. Which medication is most likely responsible for this patient’s presentation?
A 35-year-old woman presents to the Pharmacology Clinic for evaluation. Her primary care physician has referred her for hypertension management as she plans to conceive her first child soon, and the doctor is uncertain about how to proceed. Upon examination, her blood pressure is 155/95 mmHg, and her pulse is regular at 75 bpm. Her BMI is 23 kg/m2, and renal function testing and renal tract ultrasound are normal. She is believed to have essential hypertension. What is the most effective treatment for her high blood pressure?
A 32-year-old male visits his primary care physician (PCP) complaining of dystonia after being given metoclopramide for vomiting and diarrhoea. What is the most suitable medication to treat his dystonic reaction?
An 81-year-old woman presents with progressive memory loss and leg weakness. She resides in a nursing home and has difficulty walking and recognizing her caregivers. She has a 22-year history of type 2 diabetes mellitus and takes metformin, as well as atenolol, enalapril, and verapamil for hypertension, and trimethoprim for recurrent urinary tract infections. Her MMSE score has decreased from 22/30 six months ago to 11/30 today. On examination, she appears pale and has pale conjunctiva. Neurological examination reveals reduced tone, power, and co-ordination with absent reflexes and upward plantar responses. Her blood count shows low Hb and MCV, and her B12 and folate levels are also low. What is the most likely cause of her B12 deficiency?