im
HIV - 12-31-07 12:32
. A 19-year-old man comes to the physician because of frequent nosebleeds over the past 3 weeks. He has bipolar disorder currently well controlled with lithium carbonate, bupropion, and valproic acid. Physical examination shows no abnormalities except for dried blood in the nares. Mental status examination shows an anxious mood and slight motor restlessness. Serum studies show a lithium carbonate level of 1.3 mEq/L (therapeutic range=0.6–1.2), and valproic acid level of 77 μg/mL (therapeutic range=40–100). Which of the following is the most appropriate next step in management?
A) Measurement of serum aspartate aminotransferase (AST, GOT) activity
B) Measurement of serum bupropion level
C) Platelet count
D) Discontinuation of lithium carbonate therapy
E) Discontinuation of valproic acid therapy
HIV - 12-31-07 12:32
. A 19-year-old man comes to the physician because of frequent nosebleeds over the past 3 weeks. He has bipolar disorder currently well controlled with lithium carbonate, bupropion, and valproic acid. Physical examination shows no abnormalities except for dried blood in the nares. Mental status examination shows an anxious mood and slight motor restlessness. Serum studies show a lithium carbonate level of 1.3 mEq/L (therapeutic range=0.6–1.2), and valproic acid level of 77 μg/mL (therapeutic range=40–100). Which of the following is the most appropriate next step in management?
A) Measurement of serum aspartate aminotransferase (AST, GOT) activity
B) Measurement of serum bupropion level
C) Platelet count
D) Discontinuation of lithium carbonate therapy
E) Discontinuation of valproic acid therapy
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#4
Re: im 8401glacieres - 01-11-08 12:36 Really don't know the answer. I wonder if the stem is missing some part.
Bleeding manifestations r not part of any of the medications he is on.
#5
Re: im drsri117 - 01-11-08 13:17 the drugs mentioned donot manifest as nose bleeding
and a decrese platelet count does not manifest as nose bleeds either unless its less than 20,000 in which case hed surely have presented with additional symptoms
im guessing liver dysfunction leading to clotting factor deficiency and bleeding manifestation??
if a choice of cocaine snorting was given would have been a perfect answer(considering the symptoms,the bipolar disorder and the age)
#7
Re: im ammulufy - 06-30-10 21:09 First of all I dont know whther nose bleed is one of d side-effects of any of d drugs mentioned above.....moreover any nose bleed shud be frst evaluated by going through the coagulation pathology n ruling out lest it proves detrimental to d ptnt if not initially identified....den I wud go for estimation of serum buprione levels...derefore I go wid C followed by B.
#8
Re: im bingousmle - 06-30-10 21:43 Measurement of serum aspartate aminotransferase (AST, GOT) activity ???
#9
Re: im babbu5508 - 07-10-10 02:35 A) Measurement of serum aspartate aminotransferase (AST, GOT) activity...for liver functioning which might manifest as clotting factor deficiency.
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