A 63-year-old man comes to the physician for a routine health maintenance examination. He feels well. He has a history of hypertension, atrial fibrillation, bipolar disorder, and osteoarthritis of the knees. Current medications include lisinopril, amiodarone, lamotrigine, and acetaminophen. He started amiodarone 6 months ago and switched from lithium to lamotrigine 4 months ago. The patient does not smoke. He drinks 1–4 beers per week. He does not use illicit drugs. Vital signs are within normal limits. Examination shows no abnormalities. Laboratory studies show: Serum Na+ 137 mEq/L K+ 4.2 mEq/L Cl- 105 mEq/L HCO3- 24 mEq/L Urea nitrogen 14 mg/dL Creatinine 0.9 mg/dL Alkaline phosphatase 82 U/L Aspartate aminotransferase (AST) 110 U/L Alanine aminotransferase (ALT) 115 U/L Which of the following is the most appropriate next step in management?
ADiscontinue amiodarone
BDiscontinue acetaminophen
CFollow-up laboratory results in 3 months
DFollow-up laboratory results in 6 months
EDecrease alcohol consumption
A 14-year-old boy is brought to the emergency department because of a 4-hour history of vomiting, lethargy, and confusion. Three days ago, he was treated with an over-the-counter medication for fever and runny nose. He is oriented only to person. His blood pressure is 100/70 mm Hg. Examination shows bilateral optic disc swelling and hepatomegaly. His blood glucose concentration is 65 mg/dL. Toxicology screening for serum acetaminophen is negative. The over-the-counter medication that was most likely used by this patient has which of the following additional effects?
AIncreased partial thromboplastin time
BDecreased uric acid elimination
CDecreased expression of glycoprotein IIb/IIIa
DIrreversible inhibition of ATP synthase
EIrreversible inhibition of cyclooxygenase-1
A 75-year-old female patient comes to the emergency department with altered mental status. She is brought in by her daughter with whom the patient lives. The patient’s daughter said they were watching TV when her mother became unresponsive. On exam the patient withdraws to pain but does not open her eyes or speak. An emergent head CT is done and shows an intracranial bleed. The patient is moved to the ICU and intubated. Further history is obtained from the daughter. The patient has a past medical history of diabetes and a previous stroke. Her medications are metformin and warfarin. The patient is compliant with all of her medications. The daughter says that the patient changed her diet about 1 month ago in response to a diet she saw on a talk show. Which of the following foods is most likely to cause the pathology seen in this patient?
AGrapefruit juice
BSt. John’s wort
CGreen tea
DChili peppers
ESpinach
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