An 80-year-old nursing home resident with end-stage dementia has an acute bowel obstruction; she is not a suitable candidate for surgical intervention.
Which of the following medications may be most effective in reducing her discomfort?
A 67-year-old man on palliative chemotherapy for advanced lung cancer is brought to the Emergency Department by his wife as he has been feeling increasingly weak and lethargic over the past few days. His arterial blood gas results are below:
Investigation Result Normal range
pH 7.51 7.35–7.45
Partial pressure of oxygen (PaO2) 11.7 kPa > 11 kPa
Partial pressure of carbon dioxide (PaCO2) 5.5 kPa 4.7–6.0 kPa
Bicarbonate (HCO3−) 29 mEq/l 22–26 mEq/l
Base excess +3 -2 to +2
Which of the following is most likely to cause this result?
A 38-year-old woman is visited by her GP at home. She is nearing the end of her life due to metastatic cervical cancer and is currently receiving diamorphine through a syringe driver. Her family is worried because she has been experiencing increasing confusion and severe pain over the past few days. Her recent blood tests, including FBC, LFT, calcium, and CRP, are all normal. However, her renal function has significantly declined since her last blood test two weeks ago. On examination, the GP notes that she has small pupils and normal respiratory rate and oxygen saturation. The patient wishes to remain at home for her care and end-of-life, and does not want to be hospitalized under any circumstances. What would be the most appropriate management plan?
A 55-year-old woman presents to the Oncology Ward with vomiting three days after receiving chemotherapy for non-Hodgkin’s lymphoma (NHL). She is also experiencing muscle spasms in her hands and feet and has severe muscle weakness.
The patient’s blood test results are shown below:
Investigation Result Normal range
Sodium 144 mmol/l 135–145 mmol/l
Potassium 6.7 mmol/l 3.5–5.0 mmol/l
Uric acid 600 µmol/l 140–360 µmol/l
Creatinine 168 µmol/l 68–98 µmol/l
Calcium 1.60 mmol/l 2.05–2.60 mmol/l
Phosphate 2.4 mmol/l 0.8–1.50 mmol/l
Creatine kinase 65 U/l 25–200 U/l
What is the most likely diagnosis?
A 60-year-old man visits his GP with metastatic lung cancer. He reports taking 1 g of paracetamol four times daily and codeine 60 mg four times daily, but is still experiencing pain. What is the best course of action for managing his pain?
An 85-year-old man with renal failure attends hospital for dialysis three times per week. He presents to the Emergency Department with acute shortness of breath and is found to have suffered from a large anterior myocardial infarct. The medical team decides to discuss a DNACPR decision with him. When is it appropriate to consider a DNACPR order?
A new medication, called Lasarex, is being tested to increase the chances of survival for patients with pancreatic cancer. The pharmaceutical company conducting the study is currently determining the appropriate dosage.
As per their calculations, administering 900 mg of the drug orally results in only 540 mg reaching the systemic circulation, and just 180 mg reaching the cancer cells.
What is the bioavailability of this medication?
A new medication, Lumibrite, is being tested to enhance bone density in postmenopausal women. The pharmaceutical company conducting the study is trying to determine the appropriate dosage.
They have found that if 2500 mg of the medication is administered orally, only 1800 mg reaches the systemic circulation and only 700 mg reaches the bone tissue. What is the bioavailability of Lumibrite?
A pharmaceutical company is currently testing a new medication, Xylozyme, for the treatment of Parkinson’s disease. Phase 2-3 trials are being conducted to determine the drug’s clearance rate. The drug is primarily cleared through the hepatic system.
A blood sample is taken at timed intervals through an IV. One sample is taken with a blood volume of 150 ml. The drug concentration in the blood is 20 mg/L and the urine concentration at the same time is 5 mg/L.
What is the clearance rate of the drug in liters per unit time?
A new drug, Dangerex, is being tested as an antidepressant with a lower risk of overdose and suicide. In phase 1 and 2 trials, 500 mg of the drug was administered intravenously to elderly volunteers. Shortly after, the plasma concentration was measured at 3 mg/L. What is the volume of distribution of Dangerex in litres?