A 78 year old lady is admitted to the Acute Medical Unit with a fall. She has a mid stream urine which grows E. coli, and is diagnosed with a urinary tract infection. On examination, she is hypotensive and has dry mucous membranes. She has a background of hypertension, atrial fibrillation and pedal oedema. Her bloods are as follows, with most recent GP blood results in brackets: Na: 135 (134) K: 5.0 (4.5) Urea: 24.6 (18.1) Creatinine: 237 (118) Corrected Calcium: 2.25 (2.2) Haemoglobin: 123 (133) White Cell Count: 6.8 (9.2) Her regular medications include: Atorvastatin 40mg nocte Warfarin 2mg Wed-Thurs, 3mg Fri – Tues Furosemide 80mg mane, 40mg evening Lisinopril 2.5mg mane Please select the most appropriate change to this lady’s medication:
A Stop her night time atorvastatin dose
B Suspend her warfarin today
C Suspend her morning furosemide dose only
D Suspend her lisinopril morning dose only
E Suspend both her furosemide and lisinopril doses, both morning and night
A 81 year old lady is admitted to the Acute Medical Unit with confusion. The clerking notes state that she is ‘off legs’ and not coping at home. She has not opened her bowels in 4 days. She is started on IV sodium chloride 0.9% 1L over 8 hours. Her admission bloods are as follows, with most recent GP blood results in brackets: Na: 131 (132) K: 4.0 (4.2) Urea: 11.4 (9.1) Creatinine: 145 (90) Corrected Calcium: 2.85 (2.3) Haemoglobin: 121 (115) White Cell Count: 9.1 (7.3) Her medication list includes: Atenolol 25mg mane Senna 2 sachets nocte Adcal D3 2 tablets, twice a day Amitriptyline 10mg note Please select the most appropriate change to this lady’s medication:
A Suspend this lady’s night time amitriptyline
B Discontinue the patient’s Adcal D3
C Change this lady’s Senna to Sodium Docusate 200mg
D Discontinue Atenolol 25mg
E Change sodium chloride 0.9% IV to 1L 5% dextrose IV
An 88 year old gentleman is admitted to the respiratory ward with an infective exacerbation of COPD. He is confused, with an AMTS of 3/10. His wife states he is not normally like this. He unfortunately has a fall on the ward in the night, and you are asked to review his regular medication, which is as follows: Perindopril 4mg mane Macrogol oral powder (Movicol) 1-2 sachets twice daily Codeine phosphate 60mg QDS Sertraline 50mg mane Please select the most appropriate action to take at this point.
A Reduce dose of perindopril to 2mg mane
B Change Movicol to Sodium Docusate 200mg
C Reduce Codeine phosphate to 15-30mg PRN QDS and review analgesia
D Discontinue Codeine phosphate
E Change Sertraline to Mirtazepine 15mg
A 71 year old gentleman was admitted to the respiratory ward with community acquired pneumonia. He is started on amoxicillin IV 500mg BD. He has a past medical history of osteoarthritis and atrial fibrillation, on warfarin. His regular medication includes: Paracetamol 1000mgPRN QDS Senna 2 sachets nocte Warfarin 2mg daily – INR Target 2.5-3.5 Two days following admission, his INR is found to be 4.5. He is asymptomatic. What is the most appropriate action to take at this point?
A Omit warfarin today and recheck INR tomorrow
B Give warfarin 2mg as normal and recheck INR tomorrow
C Increase dose of warfarin to 3mg today
D Increase dose of warfarin to 4mg today
E Give 10mg IV Vitamin K stat
A 59 year old gentleman with a past medical history of type 2 diabetes is admitted to the Acute Medical Unit with nausea and vomiting. Three days after admission, during the night, you are asked to review this gentleman as his blood glucose is 2.9. After giving glucogel oral, his blood glucose increases to 5.0. His regular insulin regime is Levemir 8 units in the morning. Please select the most appropriate action to take regarding this gentleman’s insulin.
A Omit his morning Levemir
B Decrease his morning Levemir to 6 units tomorrow
C Decrease his morning Levemir to 2 units tomorrow
D Increase his morning Levemir to 10 units tomorrow
E Refer to the consultant diabetologist
A 72 year old with a past medical history of hypertension and rheumatoid arthritis is admitted to the respiratory ward with a community acquired pneumonia. His medication list includes the following: Atorvastatin 80mg nocte Methotrexate 2.5mg on Tuesdays Naproxen 250mg twice daily Codeine 15-30mg QDS PRN Paracetamol 1000mg QDS PRN A decision is made to commence this gentleman on IV Amoxicillin and Clarithromycin. Please select the most appropriate action to take regarding this gentleman’s regular medication.
A Discontinue Atorvastatin 80mg nocte
B Discontinue Methotrexate 2.5mg
C Discontinue Naproxen 250mg twice daily
D Discontinue Codeine 15-30mg QDS PRN
E Discontinue Paracetamol 1000mg QDS PRN
A 71 year old man is admitted to the medical ward following a chest infection. He is commenced on 1.2g co-amoxiclav IV. When reviewing his medication list, which of the following would be most appropriate to be discontinued?
A Apixaban
B Atorvastatin
C Citalopram
D Nystatin
E Omeprazole
An 85 year old lady was admitted after a collapse, and is due for a cardiology review after the weekend. She appears to be acutely confused and disorientated. You are asked to review her medications. Which of the following regular medications are most likely to have contributed to her delirium?
A Bisoprolol 1.25mg OD PO
B Cetirizine 10mg OD PO
C Codeine 60mg QDS PO
D Digoxin 125micrograms OD PO
E Sodium valproate 1g OD PO
