A 63-year-old man, who is on warfarin, visits his GP for a blood test to check his international normalised ratio (INR). He has a medical history of atrial fibrillation and epilepsy. His desired INR range is between 2 and 3. However, the test shows an INR of 4. When asked, he discloses that he has recently begun taking a new drug.
Which medication is the probable cause of the INR alteration?
A 50-year-old woman visits her doctor with new symptoms of flushing, severe insomnia, and headaches. She has a medical history of asthma and a spontaneous deep vein thrombosis. These symptoms are affecting her daily routine, and she has not had her period for 12 months. After discussing the benefits and risks of hormonal replacement therapy, they decide to start treatment. What is the most suitable hormonal replacement therapy regimen for this patient?
A 50-year-old farmer presents to the Emergency Department with a one day history of faecal and urinary incontinence. He is normally healthy, and only takes sertraline for depression. He is alert, but appears uneasy and sweaty.
Upon examination, his chest is clear, and heart sounds are normal, while his pupils are 1mm in diameter, and reactive to light bilaterally. His abdomen is soft and non-tender, and peripheral neurological examination is normal, except for occasional lower limb fasciculations.
His vital signs are as follows: respiratory rate 16/min; oxygen saturations 97% on air; temperature 36.2ºC; heart rate 50 beats per minute; blood pressure 99/60 mmHg.
What is the most probable diagnosis?
A 56-year-old cleaner is diagnosed with a T-score of -2.7 after a DXA scan to evaluate bone density due to experiencing two fractures within a year. Bisphosphonate therapy once weekly and a vitamin D supplement are initiated. What is the target cell type of bisphosphonates?
A 50-year-old man with lung cancer is on ibuprofen for pain management. He arrives at the Emergency Department with melaena and a haemoglobin level of 8.0.
What medication is most likely responsible for his symptoms?
A 75-year-old man is admitted to the hospital with severe abdominal pain and increased confusion. His family reports that he has been having difficulty walking. Upon examination, a full abdomen with a palpable bladder is noted. A prostate examination reveals a smooth, slightly enlarged prostate with an empty rectum. A bladder scan shows 1 L of urine in his bladder. The patient’s medication list includes aspirin, fexofenadine, ramipril, paracetamol, prazosin, and insulin. Which medication is most likely responsible for this presentation?
A 67-year-old man presents to the emergency department with unilateral limb weakness and slurred speech. A CT scan of the head reveals a haemorrhagic stroke, but the medical team has no access to his records as he was found on the street. However, a warfarin card is discovered in his wallet. Upon conducting blood tests, his International Normalised Ratio is found to be 8.5. Which medication from his history is most likely to have caused this?
A 32-year-old woman has been diagnosed with bipolar affective disorder and is taking lithium. She has a history of epilepsy. She is now experiencing symptoms of lithium toxicity and her lithium level is 1.6 mmol/L. Which medication is the most likely cause of the lithium toxicity?
A 72-year-old patient is seen in clinic. He has a medical history of osteoarthritis, asthma, type II diabetes, dyspepsia, chronic kidney disease and atrial fibrillation. He is currently taking metformin, salbutamol, paracetamol, omeprazole and digoxin. Blood tests show a continued decline in renal function, with a GFR previously at 34 ml/min/1.73 m2 now at 26 ml/min/1.73 m2. Which medication should be discontinued at this point?
Of the following, which one is the most useful prognostic marker in aspirin overdose?