I don't know if this is a step 1 type question but here you are:
72 -year old lady. 3 day prior to ER visit she was in yearly control in her family practioner. DMII, HTA, hypothyroidism, muscle related backpain. Medication: bisoprolol, ramipril, primaspan, thyroxin, metformin, zopiclone, acetaminophen and tizanidin.
Patient complaints backpains, nightly pain in both knees, and symptoms of urinary tract infections which were begin same day. Laboratory test HbA1C 7,5% or 59 mmol/mol. Elevated cholesterol levels. CBC and CRP normal. Urine sample positive nitrite and leukocyte. In physical examination gradus I systolic murmur in right parasternal auscultation site, no renal tenderness. Temperature normal. ECG showed hypertrophic left ventricle. In home measurements avarage bloodpressure 155/90 pulse 75.
Family practioner elevated patients metformin dosage, started simvastatin for elevated risk of stroke or myocardial infarction, elevated bisoprolol dosage because of high blood pressure and advised to use acetaminophen and tizanidin for muscle related backpain. For urinary tract infection ciprofloxacin was prescribed.
In ER the patient was admitted for hypotension. Blood pressure 65/40 and pulse 55. Otherwise physical examination was unremarkable, but patient was sleepy. Patient didn't complaint any acute pain. Laboratory measurements were unremarkable. ECG with no remarkable findings.
Patients condition was most likely caused by:
A) high dose of bisoprolol
B) adverse effect of simvastatin
C) non-ST-elevation myocardial infarction
D) elevation of metformin
E) prescribed ciprofloxacine
F) urosepsis of highly resistant bacteria
72 -year old lady. 3 day prior to ER visit she was in yearly control in her family practioner. DMII, HTA, hypothyroidism, muscle related backpain. Medication: bisoprolol, ramipril, primaspan, thyroxin, metformin, zopiclone, acetaminophen and tizanidin.
Patient complaints backpains, nightly pain in both knees, and symptoms of urinary tract infections which were begin same day. Laboratory test HbA1C 7,5% or 59 mmol/mol. Elevated cholesterol levels. CBC and CRP normal. Urine sample positive nitrite and leukocyte. In physical examination gradus I systolic murmur in right parasternal auscultation site, no renal tenderness. Temperature normal. ECG showed hypertrophic left ventricle. In home measurements avarage bloodpressure 155/90 pulse 75.
Family practioner elevated patients metformin dosage, started simvastatin for elevated risk of stroke or myocardial infarction, elevated bisoprolol dosage because of high blood pressure and advised to use acetaminophen and tizanidin for muscle related backpain. For urinary tract infection ciprofloxacin was prescribed.
In ER the patient was admitted for hypotension. Blood pressure 65/40 and pulse 55. Otherwise physical examination was unremarkable, but patient was sleepy. Patient didn't complaint any acute pain. Laboratory measurements were unremarkable. ECG with no remarkable findings.
Patients condition was most likely caused by:
A) high dose of bisoprolol
B) adverse effect of simvastatin
C) non-ST-elevation myocardial infarction
D) elevation of metformin
E) prescribed ciprofloxacine
F) urosepsis of highly resistant bacteria