USMLE Forum Archives - USMLE Step 2 CK - int.med/pharm
int.med/pharm
ysemak - 10-22-09 13:17
A 72y/o man presents for his annual physical examination. He has not had any medical illnesses over the past year. He formerly drank several cocktails before dinner for many years and has a history of a variceal bleed 2 years ago, but has not re-bled since. His only medications are aspirin and metoprolol. On physical examination, he is afebrile. His BP is 122/68 mm Hg, P-60/min, and respirations are 14/min. He is anicteric and has no stigmata of chronic liver disease. His liver edge is 9 cm in the m/cl. line by percussion, and no spleen tip is palpable. There is no evidence of ascites or peripheral edema. Which of the following medications should the patient most likely avoid?
ysemak - 10-22-09 13:17
A 72y/o man presents for his annual physical examination. He has not had any medical illnesses over the past year. He formerly drank several cocktails before dinner for many years and has a history of a variceal bleed 2 years ago, but has not re-bled since. His only medications are aspirin and metoprolol. On physical examination, he is afebrile. His BP is 122/68 mm Hg, P-60/min, and respirations are 14/min. He is anicteric and has no stigmata of chronic liver disease. His liver edge is 9 cm in the m/cl. line by percussion, and no spleen tip is palpable. There is no evidence of ascites or peripheral edema. Which of the following medications should the patient most likely avoid?
The correct answer and explanation will be available after you answer.
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#6
Re: int.med/pharm conym5 - 11-17-09 09:08 My answer is: b.
a patient with a history of a variceal bleed should avoid Ibuprofen (any NSAID) to reduce the risk of bleeding...no indications for Ciprofloxacin ,Prednisone , Lorazepam , losartan...
#8
Re: int.med/pharm amitm15 - 11-17-09 10:37 hi in this question patient is having no feature of chronic or acute liver disease and as such is not at risk of developing hepatic encephalopthy. however BZD are predisposing factor for hepatic encephalopathy, but in my opinion use of NSAID is a more of a risk factor for rebleeding, because of the earlier episode of upper GI bleed.
in addition to this on examination patient is having no feature of chronic liver disease, normal liver span which may be normal or increased and most important no feature of portal hypertension like hepatomegaly, ascitis, spleenomegaly.
#9
Re: int.med/pharm
ysemak - 11-17-09 11:54 that's not my Q-n. My answer was wrong too.
About NSAIDs- p-t is already on aspirin, so I think ibuprofen is more safer.
#23
Re: int.med/pharm ammulufy - 03-14-10 11:24 My answer is: d.
Though now the patient is asymtomatic for any chronic liver disease,due to prolonged alcohol history ptnt has set into hepatic dysfunction as noted by sigfig hepatomegaly......n he seems to be a known hypertensive....hence as losartan is metabolised in liver it is the drug whch is to be avoided.
#27
Re: int.med/pharm mtniharika - 04-30-10 05:42 My answer is: b.
a patient with variceal bleed should avoid non-steroidal anti-inflammatory drugs as it may precipitate variceal bleed in such patients....
#28
Re: int.med/pharm babbu5508 - 05-21-10 14:22 My answer is: b.
a patient with variceal bleed should avoid non-steroidal anti-inflammatory drugs as it may precipitate variceal bleed in such patients...n hes already on aspirin
#37
Re: int.med/pharm vishalsheth - 08-28-10 09:47 My answer is: e.
this has nothing to do with the case
he seems norma'
#45
Re: int.med/pharm babbu5508 - 09-30-10 16:42 benzodiazepines increase the risk of hepatic encephalopathy in this patient with risk factors and therfore to be avoided.....
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