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Patient TH (75 years old, weight 80 kg) has recently been diagnosed with a non-ST segment elevation myocardial infarction (NSTEMI). Prior to this he did not take any medication and had no significant past medical history. He has no drug allergies or intolerances. He is NOT at an increased bleeding risk. Which is the MOST APPROPRIATE regimen for Patient TH to have initiated as secondary prevention?

Patient PO (male, 23 years old, weight 70 kg) is in hospital being treated for poisoning. They are being correctly treated according to guidelines and administered activated charcoal to enhance the elimination of the overdosed substance. Which drug is MOST LIKELY to have been ingested?

Patient LW (31 years old, weight 70 kg) has a prior history of an overdose attempt. He is currently being treated for depression and has decided with his doctor that he would like to start an antidepressant medication. The doctor asks you which would be the MOST suitable in this case in terms of concerns regarding overdose. From the options below which would be the MOST APPROPRIATE suggestion?

Patient UE (58 years old, weight 89 kg) presents to the walk-in centre complaining of shortness of breath and a sharp pain when breathing in, plus feeling generally ‘awful’. On examination she is pale, her oxygen saturations are 88% on air, her heart rate is 112 beats per minute, blood pressure 109/78 mmHg, temperature 37°C. She denies any recent travel, she does not smoke nor drink alcohol. Her drug history is: Elleste-Solo tablets 1 mg daily which she takes for symptoms of the menopause. She has no other significant medical history. A two-level PE Wells score is calculated. From the information provided, what course of action would seem MOST APPROPRIATE?

Patient EW (62 years old, weight 80 kg) has been admitted to hospital and diagnosed with a ST-elevation myocardial infarction (STEMI). He HAS undergone primary percutaneous coronary intervention (PCI). Past medical history: Hypertension Hypercholesterolaemia Medication history: amlodipine 10 mg once daily atorvastatin 20 mg once daily He is NOT at an increased bleeding risk. Which antiplatelet regime is MOST APPROPRIATE for Patient EW?

Patient RE (male, 65 years old, 88 kg, height 170 cm) has been diagnosed with prosthetic valve endocarditis. He has been prescribed the following regime: Intravenous flucloxacillin 2 g six times per day Oral rifampicin 400 mg three times per day Intravenous gentamicin 3 mg/kg per 24 hours for the first 2 weeks Past medical history: prosthetic mitral valve replacement (15 years ago) hypertension Medication history: warfarin as per INR indapamide modified release 1.5 mg once daily lisinopril 20 mg daily. Which statement is CORRECT?

Patient PU (female, 55 years old, weight 80 kg) has become severely unwell with a skin problem, described in her notes as ‘detachment of around 5% of Body Surface Area with widespread erythematous macules’. This was preceded by an upper respiratory tract infection with a fever and headache, before the lesions suddenly developed. Which is the MOST LIKELY diagnosis?

Patient JS (71 years old, weight 93 kg) has presented with a painful, swollen joint affecting the big toe on his right foot. It is hot to the touch and red. Past medical history Hypertension Hypercholesterolaemia Heart failure Chronic Kidney Disease Stage 3a (eGFR 55 ml/min/1.73m2) Medication history Atorvastatin 20 mg once daily Lisinopril 20 mg once daily Furosemide 80 mg in the morning, 40 mg lunchtime (increased 2 weeks ago) Paracetamol 1 g four times daily Multivitamin ONE tablet once daily (buys over the counter) no known drug allergies A diagnosis of an acute flare of gout is made. What is the MOST LIKELY cause of this acute flare of gout in Patient JS?

Patient CL (female, 44 years old, weight 63 kg) has been admitted to the surgical ward with acute abdominal pain and diagnosed with suspected appendicitis. She is nil by mouth prior to an appendectomy. Her current pain score is 9/10. Past medical history: Asthma Medication history: Salamol Easi-Breathe 100 micrograms/puff inhaler two puffs when required Which approach to pain management is MOST APPROPRIATE?

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