QuestionSBA
QuestionChoice
Venous thromboembolism is not a recognised side effect of atorvastatin. Therefore, there is no need to stop this drug.
50433
e
Stop atorvastatin
QuestionChoice
Venous thromboembolism is not a recognised side effect of amlodipine. Therefore, there is no need to stop this drug.
50431
c
Stop amlodipine
QuestionChoice
Venous thromboembolism is not a recognised side effect of paracetamol. Therefore there is no need to stop this drug.
50432
d
Stop paracetamol
QuestionChoice
This patient has presented with a DVT. Patients who are taking tamoxifen are at an increased risk of developing blood clots. This is because the liver produced more clotting factors in response to processing more oestrogen. This patient should have her hormone replacement therapy switched over to a patch or gel.
50429
a
Stop tamoxifen
QuestionChoice
Venous thromboembolism is not a recognised side effect of ramipril. Therefore, there is no need to stop this drug.
50430
b
Stop ramipril
QuestionComment
why cant this be cellulitis - in which case the pt would be started on flucloxacillin - in BNF interactions paracetamol and flucloxacillin are listed as severe interactions
60948
QuestionComment
The interaction listed in the BNF is high anion gap metabolic acidosis (anecdotal evidence quality), which is unlikely present as a DVT and more like DKA or aspirin OD
61184
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subscriber
DJnR
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Schistosomiasis
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
3669
Tamoxifen increase the risk of venous thromboembolisms
Topic
131
Obstetrics & Gynaecology/Paediatrics
10140
Case Presentation:  A 54-year-old woman attends her GP complaining of a sore leg.


**PMH**
Hypertension, hypercholesterolaemia
**DH**
Ramipril 10mg PO OD, amlodipine 10mg PO OD, atorvastatin 20mg PO OD, tamoxifen 20mg PO OD, paracetamol 1g PO QDS
**Examination**
The right calf appears red, swollen and painful to touch. When compared to the other leg it is around 3cm bigger. Their observations are normal.

Question: Select the most appropriate decision option based on this data.
a