QuestionSBA
QuestionChoice
Metallic taste is not a listed side effect of unfractionated heparin.
50353
e
He is likely to experience a metallic taste in his mouth as a side effect of unfractionated heparin
QuestionChoice
This patient has chronic kidney disease stage 4, this means his eGFR is 15-29 ml/min. Hyperkalaemia is a recognised risk of chronic kidney disease, especially in the later stages of the disease. Unfractionated heparin inhibits aldosterone secretion, this in turn increases the risk of hyperkalaemia. As this patient is already predisposed to hyperkalaemia it is important to measure their potassium levels before giving unfractionated heparin and during their stay in hospital.
50349
a
He will need to have his potassium checked before he has his heparin
QuestionChoice
Alopecia is listed as a rare/very rare side effect of unfractionated heparin use, therefore they are not very likely to occur.
50352
d
He is likely to experience hair loss whilst taking unfractionated heparin
QuestionChoice
Hepatic function is not routinely monitored in patients using unfractionated heparin.
50350
b
He will need regular hepatic monitoring
QuestionChoice
Thyroid function is not routinely monitored in patients using unfractionated heparin.
50351
c
He will need regular thyroid function tests for monitoring
Concept
Chapter
Osteoporosis, otherwise known as thin bones, is a condition associated with high risk of low trauma fractures due to reduced bone mineral density. Osteoclast activity exceeds osteoblast activity, meaning that bone resorption is occurring at a greater rate than bone formation.

**Symptoms and Signs**

- Generally asymptomatic until a fragility fracture occurs
- Back pain
- Kyphosis (stooped posture)
- Fragility fractures

**Risk factors**

- Female sex
- Increasing age
- Smoking
- Corticosteroid use
- Low BMI (< 20-25kg/m<sup>2</sup>)
- Low body weight (<58kg)
- Vitamin D deficiency

**Protective factors**

- Higher BMI
- Exercise - mechanical loading stimulates bone formation

**Diagnosis**
Osteoporosis can be detected on dual-energy x-ray absorptiometry (DEXA) scan.
A T score of < -2.5 indicates osteoporosis

**Management**

- Fall prevention
- Vitamin D and calcium supplementation
- Hormone replacement therapy (postmenopausal women)
- Oral bisphosphonates
2657
3653
Unfractionated heparin requires potassium levels to be measured prior to initiating treatment in patients with chronic kidney disease
Topic
13
Neurosurgery
10124
Case presentation: A 64-year-old man is admitted to hospital for elective surgery. He has known oesophageal cancer and is having a subtotal oesophagectomy to remove his tumour.



**PH**
Oesophageal cancer, chronic kidney disease (stage 4)

**DH**
Ramipril 10mg PO OD, atorvastatin 20mg PO OD, epoetin alfa 3500 units IV BD

As this gentleman is having surgery, he needs to be prescribed unfractionated heparin

Question: Select the most important information that should be provided for this patient.
a