A 32-year-old man is brought into the Emergency Department from a party with sudden onset chest pain and extreme agitation. His blood pressure is 136/94 mmHg and his pulse rate is 49/min. A collateral history from his partner suggests the use of illicit drugs.
On examination, he has brisk reflexes bilaterally.
An ECG shows QT prolongation and ST elevation in V1-V4.
What is the probable pathophysiology behind this patient’s presentation?
Patients who have been taking amiodarone for a prolonged period of time may experience what issues related to thyroid function?
A 65-year-old patient, with advanced liver cirrhosis and a diagnosis of hepatocellular carcinoma, is experiencing intense back pain. Considering his liver dysfunction, which medication would be the most appropriate for pain relief?
A patient is seen in the Psychiatric Clinic. He is a 28-year-old diagnosed with schizophrenia. He has been taking olanzapine for two months now. He reports all the changes in his life – he has now given up smoking, cut down on drinking alcohol and is drinking lots of fruit juice. He is taking St John’s Wort on the recommendation of a friend and has stopped taking regular ibuprofen, as his back pain has improved. You are concerned that his dose of olanzapine may need to be reduced.
Why might the olanzapine dose need to be reduced for this patient?
A teenage girl with emotionally unstable personality disorder tries to end her life after a breakup with her boyfriend. She ingests paracetamol in a staggered manner but regrets it and rushes to the emergency department for help. The doctors start her on N-acetylcysteine, but she experiences a reaction to the medication transfusion. What could be the probable reason for her adverse reaction?
A 28-year-old man has been brought to the emergency department at 16:00 after taking an overdose of paracetamol. He has disclosed that he attempted suicide due to feeling overwhelmed with his postgraduate studies and has been feeling particularly lonely since he moved to university. The patient has admitted to taking 25 paracetamol tablets throughout the day since waking up at 07:00, but cannot recall when he last took some of the tablets, except that it was before 14:00. What would be the most appropriate course of action now?
A 16-year-old male has presented to the emergency department after taking an overdose of paracetamol. His paracetamol levels were recorded on admission and the decision to treat with IV acetylcysteine was made. Upon admission, his physical observations were all within normal ranges.
While attending to another patient, you are urgently called to reassess this young male. He is now complaining of severe shortness of breath and describes himself as feeling ‘funny’. The IV acetylcysteine was started 10 minutes ago. The nurse has kindly carried out a set of observations for you below.
Respiratory rate – 32 breaths per minute
Oxygen saturations – 87%
Blood pressure – 114/71 mmHg
Heart rate – 106bpm
Temperature – 37.1ºC
What is the most appropriate response to this situation?
A 78-year-old man with atrial fibrillation was admitted to hospital with a fractured neck of femur. He was maintained on digoxin 187.5 μg daily. On examination, his pulse was 70 bpm and his blood pressure was 124/76 mmHg. He was fully conscious.
Investigation: plasma digoxin (taken at least 6 hours post-dose) 2.5 nmol/l (1.0–2.0)
What is the most appropriate action regarding his digoxin dosage?
A 57-year-old man who smokes 20 cigarettes daily developed heart failure post-myocardial infarction. He is prescribed ramipril but decided to stop it due to a persistent dry cough.
What is the mechanism of an angiotensin-converting enzyme (ACE) inhibitor-related cough?
A 67-year-old woman develops a urinary tract infection (UTI) and is prescribed amoxicillin. She has a medical history of well-controlled type II diabetes mellitus with metformin and atrial fibrillation managed with warfarin. She has been consuming multiple glasses of cranberry juice daily, as she was informed it could prevent UTIs. During a routine check-up, her INR is found to be 6. How does cranberry juice impact the INR?