A 33-year-old woman who has never given birth before comes for her first prenatal visit at 29 weeks gestation. She is currently taking fluoxetine and lactulose and is concerned about the potential risks to her baby. What is a possible danger of using fluoxetine during the third trimester of pregnancy?
A 49-year-old man is brought to the emergency department after being found wandering the streets in an agitated state. His medical history includes hepatic steatosis, hypertension, and asthma, and he regularly takes amlodipine and Symbicort. He drinks up to 1 liter of vodka daily and has smoked for 30 years. He has not been seen by his family for 2-3 days before these events. His vital signs are heart rate 111 beats per minute, blood pressure 170/94 mmHg, respiratory rate 23 /min, oxygen saturations 97% on air, and temperature 37.2ºC. He is tremulous, diaphoretic, and agitated. Shortly after examination, he has a self-terminating seizure lasting 30 seconds. Blood tests and a CT head are performed, with the latter being reported as normal. What is the best medication choice to prevent further seizures?
A 31-year-old woman comes to you with complaints of worsening low mood and uncontrollable behaviors. She reports feeling distressed and finds relief only by repeating a certain phrase in her mind. She has no significant medical history and is in good physical health.
What is the symptom being described in this case?
A 54-year-old woman visited her primary care physician complaining of persistent polydipsia and swollen legs for the past few months. She reported having a medical history of chronic obstructive pulmonary disease (COPD), schizophrenia, and hypertension. Her current medications include tiotropium inhaler, ipratropium bromide inhaler, olanzapine, and nifedipine. She had previously taken bendroflumethiazide, which was discontinued two years ago, and had a 5-day course of 30mg oral prednisolone six months ago due to a COPD exacerbation. Her fasting blood tests revealed:
Fasting plasma glucose 7 mmol/L (3.9-5.4)
Random plasma glucose 12 mmol/L (<7.8)
Which medication is likely responsible for her abnormal blood results?
A woman in her early thirties is considering pregnancy while taking paroxetine. She is concerned about any potential negative effects on her pregnancy. What guidance should you provide?
A 60-year-old man is admitted from the angiography suite after the cardiologist discovered severe triple vessel disease. He awaits transfer to a tertiary hospital for a coronary artery bypass graft. After 48 hours of admission, you receive a call to see him as he has become confused, sweaty, tremulous, and agitated.
Upon reviewing his record, you note a history of asthma, variceal bleed, and cirrhosis secondary to alcohol excess. His observations show a pyrexia at 37.9ºC, heart rate of 105 bpm, and blood pressure 175/98 mmHg. What would be the most appropriate immediate intervention given the likely diagnosis?
A 21-year-old woman is admitted to the psychiatric ward. She has been awake for 4 days and is convinced that she will become the next big pop star by recording 3 albums simultaneously. When asked about her emotions, she immediately talks about her music projects, providing intricate details about each album, her plans for distribution, and her future as a famous musician. She then mentions that her mood has been fantastic because of these topics. When the conversation shifts, she continues to respond in a similar fashion. What term best describes this patient’s presentation?
A 27-year-old man dressed in casual attire has been admitted to the psychiatric intensive care unit. He is asked why he was admitted and he responds ‘It all started at my workplace, everyone is so busy making money, I’ve been busy too. I’m investing in stocks, trying to make some extra cash, I keep a record of it in my notebook, I love writing, I write all the time because I’m trying to find a cure for Alzheimer’s’. The speech is rapid and has a sense of urgency and when being asked further questions he demonstrates the same behaviour.
What best describes this patient’s behaviour?
A 28-year-old man visits the police station complaining about his wife. He tells the police she regularly physically beats their 5-year-old daughter with a belt and that she often slaps the girl. The woman is arrested by the police for hitting and brutally beating her 5-year-old daughter. When the woman is asked why she does this, she responds that, ‘This is how my mother treated me, it’s how women should act’.
Which of the following types of learning behaviour in the woman does this represent?
A 42-year-old woman is seen in the clinic after a recent visit to the psychiatrist who recommended an increase in her lithium dose for better symptom control. Her renal function is stable and you prescribe the recommended dose increase. When should her levels be re-checked?