Pаtient Prоfile: Nаme: Mr. JP Age: 82 yeаrs Weight: 55kg Sex: Male Sоcial histоry: Lives in nursing home Medical History: Anxiety COPD Depression Iron deficiency anaemia Osteoporosis Trigeminal neuralgia Current Medications: Adcal D3 2 once daily Alendronic acid 70mg once weekly Carbamazepine (Tegretol) 200mg twice a day Carbocisteine 750mg twice a day Ferrous sulphate 200mg once daily Salbutamol 100microgram inhaler 2 puffs when required Sertraline 100mg once daily Trelegy Ellipta 92/55/22 micrograms/dose one dose once daily No known drug allergies. Presenting Complaint: Mr JP is admitted into hospital due to increasing confusion and tiredness. Initial Bloods: Blood Test Result Normal Range Serum sodium 118 mmol/L mmol/L (137–144) Serum potassium 4.8 mmol/L mmol/L (3.5–5.3) Serum urea 4.2 mmol/L mmol/L (2.5–7.0) Serum creatinine 145 micromol/L (baseline 102) micromol/L (60–110) Follow up Investigations: Blood Test Result Normal Range Serum Osmolality 245 mosmol/kg mosmol/kg (275–300) Urine Osmolality 720 mosmol/kg mosmol/kg (>100) Urine sodium 74 mmol/L mmol/L (>30) Mr. JP is euvolemic and his thyroid and adrenal tests have come back normal. a. Suggest a primary differential diagnosis, including your rationale, and suggest any potential cause. (5 marks) b. Based upon your primary differential diagnosis, what would your management plan and follow up of the patient be? (7 marks) During Mr JP’s admission into hospital, he is found to have non-valvular atrial fibrillation (AF); his current HR is 92 bpm. Based on his CHA2DS2-VASc score of 2, the plan is to anticoagulate Mr JP with apixaban 5mg twice a day. c. Discuss the appropriateness of the prescription. (3 marks)
Pаtient Prоfile: Nаme: Mr. JS Age: 45 yeаrs Sex: Male Ethnicity: Caucasian Occupatiоn: Office wоrker Medical History: No significant medical history Family History: Father had hypertension No regular medications No known drug allergies Presenting Complaint: Mr. JS presents to his GP complaining of recurrent headaches, occasional dizziness, and mild fatigue. He also mentions that he has been experiencing increased stress at work. Clinical Findings: Upon evaluation, Mr. JS' blood pressure was measured at 165/95mmHg during his initial visit. His physical examination was otherwise unremarkable. Given his age, family history, and elevated blood pressure reading, a diagnosis of hypertension was made. a. Before initiating treatment, what other investigations or assessments would you carry out? (5 marks) Following further investigations, Mr. JS was diagnosed with stage 2 hypertension, and prescribed ramipril 10mg once daily. b. Comment on the appropriateness of the prescription and suggest how treatment should be monitored. (3 marks) 2 years later, Mr. JS presents to the emergency department, with a one-week history of progressively worsening weakness, palpitations, and intermittent dizziness. Current Medications: Ramipril 10 mg daily Atorvastatin 20 mg daily Acute: trimethoprim 200mg twice a day for 7 days (for urinary tract infection (UTI) 1 week ago – course completed) Diagnostic Tests: Blood Test Result Normal Range Serum sodium 140 mmol/L mmol/L (137–144) Serum potassium 6.8 mmol/L mmol/L (3.5–5.3) Serum urea 6.0 mmol/L mmol/L (2.5–7.0) Serum creatinine 105 micromol/L (baseline 102) micromol/L (60–110) Full Blood Count (FBC): Within normal limits Electrocardiogram (ECG): Showed peaked T-waves and widened QRS complex. Urine Analysis: No significant abnormalities. c. Based on the clinical presentation and laboratory findings, comment on the likely cause of Mr JS’ symptoms. Outline an appropriate clinical management plan, including doses for any treatment(s) recommended. (7 marks)