A 65-year old man presents to his primary care physician with complaints of increasing fatigue. He reports consuming 4-6 units of alcohol daily and has been on medication for a chronic medical condition for the past year. Upon examination, he appears to be in good health and well-nourished. Laboratory tests reveal an elevated gamma glutamyl transpeptidase and a decreased alkaline phosphatase (ALP). Which medication is most likely responsible for these abnormal blood results?
A 26-year-old female patient is currently being prescribed ferrous sulphate by her doctor to treat anaemia caused by menorrhagia.
What is the most frequently encountered adverse effect of taking oral iron supplements?
A 25-year-old male with severe learning difficulties is brought into the emergency department by his parents after accidentally overdosing on paracetamol. He was found 20 minutes ago to have mistakenly ingested 18 grams of paracetamol after briefly being unsupervised. What is the most appropriate initial management for this patient?
A 21-year-old man presents to the Emergency Department 50 minutes after intentionally overdosing on aspirin. He weighs 65 kg and ingested 25 tablets, each containing 250 mg. Despite the overdose, his vital signs are currently stable. What is the recommended initial course of action?
A 25-year-old man presents to the emergency department after taking an overdose of paracetamol. The patient is conscious but appears drowsy. The ambulance crew found empty paracetamol packets at the scene, indicating a dose of around 15g taken approximately 8 hours ago. Blood tests have been taken, including a paracetamol level, but results are still pending. The patient’s vital signs are stable, and he weighs 70kg.
What is the recommended course of action for management?
A 79-year-old woman is brought to the emergency department by her son after collapsing without any witnesses. Due to confusion, no medical history can be obtained. The patient has a history of depression, Alzheimer’s dementia, and atrial fibrillation and takes bisoprolol, donepezil, and amitriptyline regularly. The ambulance crew noted that she had taken an excess of her medications.
Upon examination, the chest is clear, and the patient’s oxygen saturation is 96% on room air. An ECG shows a sinus rhythm with a heart rate of 34/min. The blood pressure is 94/59 mmHg, and the Glasgow coma score is 13/15. The patient is afebrile, and her blood sugar level is 7.8 mmol/L.
What is the most appropriate initial treatment?
A young adult is a frequent attendee at hospital with recurrent attacks of drowsiness, sweating, and palpitations. The blood glucose level during one of the episodes is 2.9 mmol/l. Recovery occurs in response to intravenous 10% dextrose. C-peptide levels are measured and are found to be below the normal range.
Which of the following is the most likely diagnosis?
A 28-year-old female patient presents at the clinic for follow-up. She has been diagnosed with PCOS and is experiencing irregular and heavy menstrual cycles, excessive hair growth on her face and torso, and acne. Currently, she is taking the combined oral contraceptive pill but intends to switch to Dianette. What is the primary mechanism of action of Dianette?
A 75-year-old male is recovering on the ward after being admitted with a community acquired pneumonia. He has completed a course of antibiotics and his latest chest radiograph is clear. He is currently waiting for social services input before discharge. During the morning ward round, the patient reports new symptoms of muscle pain, weakness, and fatigue. He feels nauseous and has vomited once this morning. He has a medical history of osteoarthritis, gout, type 2 diabetes, hypercholesterolemia, atrial fibrillation, and an appendectomy as a child. He is currently taking regular paracetamol, allopurinol, metformin, simvastatin, bisoprolol, and warfarin.
Upon examination, his respiratory rate is 25/min, blood pressure is 131/85 mmHg, heart rate is 95 bpm, and temperature is 36.4ºC. Recent blood tests show:
– Na+ 140 mmol/l
– K+ 4.8 mmol/l
– Urea 12 mmol/l
– Creatinine 190 µmol/l
– eGFR 26 ml/min
– Creatine kinase 174 iu/l (normal range 25-195 iu/l)
– CRP 12 mg/l
A recent arterial blood gas (ABG) shows:
– pH 7.29
– pO2 12.1 kPa
– pCO2 4.4 kPa
– Bicarbonate 18 mmol/l
What is the most likely cause of these symptoms and investigation results?
A 36-year-old woman with a history of Von Willebrand disease underwent a left knee arthroscopy and screw removal with epidural anesthesia. The epidural space was identified at L3-L4 and local anesthetic was administered. During the operation, the patient experienced sensory block to temperature up to the T10 dermatome. After the procedure, the patient was comfortable and the block resolved completely after 2 hours. However, 2 hours later, the patient complained of severe back pain and exhibited 3/5 power in all muscle groups of the right leg, absent right patellar reflex, and reduced sensation to light touch in the right leg.
What complication of epidural anesthesia is likely to be demonstrated in this case?