Prescribing formative Flashcards
A 38 year old man, who was previously fit and well, has 3 days of persistent vomiting, diarrhoea and abdominal pain after a holiday abroad.
He has dry mucous membranes, and his abdomen is soft and non-tender. His temperature is 37.4°C, pulse rate 96 bpm, BP 100/73 mmHg, respiratory rate 16 breaths per minute and oxygen saturation 98% breathing air.
Urine output is 25 mL/hour.
Investigations:
Sodium 134 mmol/L (135–146)
Potassium 4.9 mmol/L (3.5–5.3)
Urea 16.0 mmol/L (2.5–7.8)
Creatinine 198 µmol/L (60–120)
His renal function tests done 2 weeks previously were within reference range.
- Sodium Chloride 0.9%, 1L, intravenous, over 2 hours
- Hartmann’s Solution, 1L, intravenous, over 2 hours
- Plasma-Lyte, 1L, intravenous, over 2 hours
A 59 year old man attends his GP surgery for his new patient health check. He feels well with no new concerns. He has no past medical history, and has no regular medications. His physical examination is normal. His BP is 156/86 mmHg (his records show previous readings of 152/85 mmHg and 154/86 mmHg in the last 12 months). His body mass index is 24.7 kg/m2. Fundoscopy is normal.
Investigations:
Sodium 136 mmol/L (135–146)
Potassium 4.6 mmol/L (3.5–5.3)
Urea 6.3 mmol/L (2.5–7.8)
Creatinine 96 µmol/L (60–120)
Fasting glucose 5.5 mmol/L (3.0–6.0)
Urinalysis: No abnormality
- Amlodipine, 5 mg, oral, once a day OR
- Verapamil, 120 mg, oral, twice a day OR
- Felodipine, 5 mg, oral, once a day
A 36 year old man attends the GP surgery with lower back pain after moving some heavy boxes. His is usually fit and well with no past medical history. He has no spinal tenderness, his gait and lower limb neurology is normal, and he has no saddle anaesthesia. His temperature is 37.0°C.
Please prescribe the most appropriate medication
- Paracetamol, 1g, oral, four times a day
- Ibuprofen, 400 mg, oral, three times a day
- Codeine, 15 mg, oral, four times a day
- Co-codamol 15/500, 2 tablets, oral, four times a day
A 19 year old woman is feeling fatigued. She had a history of menorrhagia and has been recently started on tranexamic acid. She is usually fit and well. She appears pale, but otherwise physical examination is normal. Her temperature is 37.3°C, pulse rate 70 bpm, BP 108/70 mmHg, respiratory rate 16 breaths per minute and oxygen saturation 99% breathing air.
Investigations:
Haemoglobin 108 g/L (115–165)
Mean corpuscular volume (MCV) 68 fL (80–96)
Ferritin 10 µg/L (12–200)
Serum folate 10 µg/L (3–15)
Serum vitamin B12 240 ng/L (160–925)
Please prescribe the most appropriate medication.
- Ferrous Fumerate, 210 mg, oral, three times a day
- Ferrous Sulphate, 200 mg, oral, three times a day
A 32 year old woman has dysuria and frequency for 2 days. Her abdomen is soft and non-tender. Her temperature is 37.3°C, pulse rate 70 bpm, BP 122/76 mmHg, respiratory rate 16 breaths per minute and oxygen saturation 100% breathing air.
Investigations:
Urinalysis: Nitrites positive,
Leukocytes 3+,
Blood trace,
Protein negative,
Glucose negative,
Ketones negative,
βHCG negative
Please prescribe the most appropriate medication
- Nitrofurantoin, 50 mg, oral, four times a day
- Trimethroprim, 200 mg, oral, twice a day
- Amoxicillin, 500 mg, oral, three times a day
- Cefalexin, 500 mg, oral, three times a day
A 68 year old man has sudden onset shortness of breath, following a knee replacement surgery a week before. He is clammy and pale. He has vesicular breath sounds. His temperature is 37.4°C, pulse rate 116 bpm, BP 104/76 mmHg, respiratory rate 24 breaths per minute and oxygen saturation 90% breathing air. He weighs 80 kg.
Investigations:
Haemoglobin 135 g/L (130–175)
White cell count 6.8 x 109/L (3.0–10.0)
Urea 3.4 mmol/L (2.5–7.8)
Creatinine 70 µmol/L (60–120)
C reactive protein (CRP) 24 mg/L (<5)
INR 1 (1) ECG: Sinus tachycardia, 116 bpm
Arterial blood gas
pH 7.49 (7.35–7.45)
pO2 7.5 kPa (11–15)
pCO2 4.2 kPa (4.6–6.4)
HCO3 24.0 mmol/L (22–30)
Please prescribe the most appropriate medication
- Dalteparin, 15000 units, subcutaneous, once a day
- Enoxaparin, 120 mg, subcutaneous, once a day
- Tinzaparin, 14000 units, subcutaneous, once a day
A 58 year old heavy goods vehicle driver has increased thirst and fatigue. His physical examination is normal, though he is overweight with a BMI of 28.3 kg/m2. His BP is 130/72 mmHg.
Investigations:
Sodium 138 mmol/L (135–146)
Potassium 4.4 mmol/L (3.5–5.3)
Urea 3.6 mmol/L (2.5–7.8)
Creatinine 66 µmol/L (60–120)
eGFR >90 mL/min/1.73m2 (>60)
Fasting Glucose 8.4 mmol/L (3.0–6.0)
Thyroid Function Tests normal
He has received structured education on diet and lifestyle.
Total Cholesterol (TC) 4.8 mmol/L (<5.0)
HDL Cholesterol 1.4 mmol/L (>1.2)
LDL Cholesterol (fasting) 3.2 mmol/L (<3.0)
Erythrocyte sedimentation rate (ESR) 14 mm/hr (<20)
Urinalysis: Glucose 3+, Protein negative, Ketones negative
• Metformin, 500 mg, oral, once a day
A 49 year old man has abdominal surgery for intestinal obstruction secondary to adhesions. The surgery was uneventful and there were no complications. He is recovering well on the wards the next day and his pain is well controlled, but he is not yet eating and drinking. His temperature is 37.3°C, pulse rate 76 bpm, BP 129/80 mmHg, respiratory rate 16 breaths per minute and oxygen saturation 99% breathing air.
Urine output 60 mL/hour.
Venous thromboembolism prophylaxis and analgesia has already been prescribed. He weighs 80 kg.
Investigations:
Haemoglobin 127 g/L (130–175)
White cell count 5.4 x 109/L (3.0–10.0)
Sodium 138 mmol/L (135–146)
Potassium 4.4 mmol/L (3.5–5.3)
Urea 7.6 mmol/L (2.5–7.8)
Creatinine 120 µmol/L (60–120)
C reactive protein (CRP) 40 mg/L (<5)
Capillary blood glucose 5.2
- Sodium Chloride 0.9%, 1 L, intravenous, over 8 hours
- Dextrose 5%, 1 L, intravenous, over 8 hours
- Hartmann’s Solution, 1 L, intravenous, over 8 hours
An 80 year old woman has redness of her right leg. She has a past medical history of diabetes mellitus and hypertension.
Her right leg is warm to touch with a well demarcated region of erythema surrounding a small area of broken skin. Her temperature is 37.6°C, pulse rate 70 bpm, BP 145/80 mmHg, respiratory rate 18 breaths per minute and oxygen saturation 98% breathing air. She weighs 80 kg.
Investigations:
White cell count 16.2 x 109/L (3.0–10.0)
Neutrophils 12.8 x 109/L (2.0–7.5)
Lymphocytes 2.6 x 109/L (1.5–4.0)
C reactive protein (CRP) 76 mg/L (<5)
Sodium 142 mmol/L (135–146)
Potassium 4.2 mmol/L (3.5–5.3)
Urea 6.2 mmol/L (2.5–7.8)
Creatinine 96 µmol/L (60–120)
• Flucloxacillin, 500 mg, oral, four times a day
A 20 year old university student is unwell with a fever, headache and intolerance to light. She has a maculopapular rash on her trunk, neck stiffness and photophobia. Her temperature is 38.2°C, pulse rate 108 bpm, BP 103/76 mmHg, respiratory rate 22 breaths per minute and oxygen saturation 99% breathing air. She weighs 50 kg.
Investigations:
White cell count 16.2 x 109/L (3.0–10.0)
Neutrophils 12.4 x 109/L (2.0–7.5)
Lymphocytes 3.8 x 109/L (1.5–4.0)
C reactive protein (CRP) 108 mg/L (<5)
Blood Culture: Awaiting result
CT Head: No abnormality detected
Lumbar Puncture: Cell count 5.2 /µL (<5)
Glucose 1.8 mmol/L (2.2–4.4)
Protein 0.92 g/L (0.15–0.45)
Gram stain positive
- Ceftriaxone, 2 g, intravenous, once a day
- Cefotaxime, 2 g, intravenous, four times a day
- Cefotaxime, 2 g, intramuscular, four times a day
A 75 year old woman has a right temporal headache which is tender to touch, and mild fever. She appears unwell. Her neurological and fundoscopy examination is normal. Her temperature is 37.9°C, pulse rate 98 bpm, BP 143/78 mmHg, respiratory rate 20 breaths per minute and oxygen saturation 98% breathing air. She weighs 60 kg. She has been prescribed paracetamol.
Investigations:
White cell count 7.2 x 109/L (3.0–10.0)
Erythrocyte sedimentation rate (ESR) 86 mm/hr (<20)
• Prednisolone, 60 mg, oral, once a day
A 25 year old woman has sudden onset palpitations with dizziness. She was previously fit and well, with no past medical history. She appears sweaty, with a rapid pulse.
Her temperature is 37.3°C, pulse rate 150 bpm, BP 118/78 mmHg, respiratory rate 18 breaths per minute and oxygen saturation 99% breathing air.
Investigations: ECG: See image.
Vagal manoeuvres are attempted, but symptoms do not resolve.
• Adenosine, 6 mg, intravenous, stat
A 59 year old man develops severe left side chest pain. He is nauseated and sweaty.
He has a past medical history of hypertension, type 2 diabetes mellitus and hypercholesterolaemia. He appears sweaty and unwell, chest is clear and heart sounds are normal.
His temperature is 37.2°C, pulse rate 80 bpm, BP 142/84 mmHg, respiratory rate 18 breaths per minute and oxygen saturation 99% breathing air.
Aspirin 300 mg has been given by the paramedics prior to arrival. He weighs 70 kg.
Investigations:
ECG: See image.
He has been given morphine and glyceryl trinitrate for pain relief.
Please prescribe the most appropriate medication.
- Clopidogrel, 600 mg, oral, stat
- Ticagrelor, 180 mg, oral, stat
- Prasugrel, 60 mg, oral, stat
A 61 year old man attends his GP Surgery for his routine health check. He has no past medical history. He is a smoker 10/day, and drinks 10 units of alcohol a week. His physical examination is normal. He weighs 90kg, and his BMI is 26.2 kg/m2
.
Investigations:
Total cholesterol (TC) 6.5 mmol/L (<5.0)
HDL cholestero1 1.0 mmol/L (>1.2)
LDL cholesterol (fasting) 3.4 mmol/L (<3.0)
Triglycerides (fasting) 2.4 mmol/L (<2.3)
Ratio of Total cholesterol (TC)/HDL 5.2 (<4.5)
His QRisk for cardiovascular disease in the next 10 years is 21%. He has been given lifestyle and smoking cessation advice, but after 12 weeks, his cardiovascular risk remains unchanged.
Urea 4.7 mmol/L (2.5–7.8)
Creatinine 76 µmol/L (60–120)
Glycated haemoglobin 38 mmol/mol (20–42)
Please prescribe the most appropriate medication.
- Atorvastatin, 20 mg, oral, once a day
- Simvastatin, 40 mg, oral, once a day
A 72 year old man is admitted to hospital for treatment of pneumonia with intravenous antibiotics.
He has a past medical history of chronic kidney disease stage 3.
His temperature is 37.4°C, pulse rate 96 bpm, BP 130/74 mmHg, respiratory rate 20 breaths per minute and oxygen saturation 96 % breathing air.
Investigations:
Sodium 136 mmol/L (135–146)
Potassium 6.5 mmol/L (3.5–5.3)
Urea 13.7 mmol/L (2.5–7.8)
Creatinine 160 µmol/L (60–120)
eGFR 39 mL/min/1.73m2 (>60)
ECG: See image.
• Calcium gluconate 10%, 10 mL, intravenous, stat
