Presentation

You are a final year medical student on an Emergency Medicine attachment. Dr. Kyriacou is your supervisor. 

Mattias Garcia, a 62-year-old man presents to the Emergency Department with his wife, complaining of diffuse muscle pain and severe muscle weakness, which started about 24 hours ago. You take a short history and establish that he was diagnosed with hypertension three years ago and dyslipidaemia a year ago. He is currently taking hydrochlorothiazide, simvastatin and low-dose aspirin. Mr Garcia is obese, and you ask about his diet. He tells you that he has recently started a new diet, the so-called grapefruit diet, which he heard was effective for weight loss. 

Investigations show elevated creatine kinase and creatinine, which is in line with the diagnosis you suspected. Dr. Kyriacou asks you to explain what has happened. 

What is the most likely explanation? 



  • Grapefruit-simvastatin interaction
  • Grapefruit-thiazide interaction
  • Grapefruit-aspirin interaction
  • Hypersensitivity reaction to medication

Map: Mattias Garcia_UNIC (1092)
Node: 20629
Score:

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Review your pathway

  • Κλινική εξέταση ειδικού νευρολόγου
  • Assess the situation to identify any potential risks to yourself or the victim. Secure the victim with the help of a third party.
  • Αλληλόμορφα
  • Наполягати на амбулаторному обстеженні та лікуванні.
  • Whatsapp
  • Laboratory Safety
  • Βασίζομαι στα φυσικά χαρακτηριστικά
  • Option 1
  • Intro
  • Reschedule without offering alternative solutions
  • Decreased entry of glucose into muscle cells
  • Increased entry of fatty acids into adipocytes
  • Increased entry of fatty acids into adipocytes
  • Χρησιμοποιώ μόνο Μεντελική πιθανότητα
  • Opțiunea 3
  • USING BASIC LABORATORY EQUIPMENT
  • Adverse effect to formoterol (LABA)
  • Un microscop care folosește o sursă de electroni pentru a mări obiectele
  • Game Over
  • Theophylline
  • Re-referral
  • Meet the patient
  • The Telemedicine Dilemma
  • Let the woman shout, shake and slap the victim.
  • Genome Sequencing
  • Μίτωση
  • Home Visit
  • Alotetaan!
  • Pipettes
  • Sacubitril-valsartan (ARNI)
  • new node
  • Start
  • Ο ασθενής σας δίνει λεπτομερές ιατρικό ιστορικό
  • Costi are 25 de ani și stă împreună cu tatăl și mama sa în minunata lor casă.
  • Option 2
  • Bisoprolol
  • Do telemedicine
  • Root Node
  • Second
  • Root Node
  • ELECTRON MICROSCOPY
  • 1cm to 10m
  • Testul cu iod
  • Πρακτική Άσκηση σε Εγκληματολογικό Εργαστήριο
  • give paracetamol
  • MICROSCOPIA ELECTRONICĂ
  • Increased elimination of cholesterol
  • Laboratorul de microbiologie alimentară
  • Last
  • Exacerbation of asthma
  • Temporarily stop taking metformin
  • What happens with the Age?
  • Διάχυση
  • ΚΥΤΤΑΡΙΚΗ ΔΟΜΗ ΚΑΙ ΛΕΙΤΟΥΡΓΙΑ
  • Do home visit directly
  • Ask local cadre to help
  • You should never use antacids
  • Ζητώ καρυότυπο
  • Decreased production of glucose from the liver
  • B, C, F
  • Opțiunea 3: Pentru a afla despre echipamentul individual de protecție (EIP) și conduita în laborator
  • Las células HeLa son naturalmente resistentes a todos los fármacos
  • Ramipril (ACE inhibitor)
  • clinical examination
  • Glyceryl trinitrate (organic nitrate)
  • ISOLATION OF DNA AND POLYMERASE CHAIN REACTION (PCR)
  • Ο ασθενής έχει αυξημένα ηπατικά ένζυμα
  • LAB SAFETY
  • Commercial Platform
  • new node
  • Amplificarea ADN-ului
  • Node 2: Discuss Maria's feelings and concerns
  • Visit by yourself
  • Προετοιμασία υγρών καλλιεργειών
  • Αιματολογικό/Βιοχημικό εργαστηριακό έλεγχο
  • *vatsan kurinaa*
  • Chief complaint
  • A microscope that uses electron source to magnify objects
  • AISLAMIENTO DE ADN Y REACCIÓN EN CADENA DE LA POLIMERASA (PCR)
  • Pertinent Negatives
  • IDENTIFICAREA BIOMOLECULELOR
  • stay home
  • Aluminum hydroxide, magnesium carbonate, sodium alginate
  • MICROBIAL CULTURE AND GROWTH
  • Lab Tests
  • Decreased entry of glucose into muscle cells
  • Τεστ Σουδάν ΙΙΙ
  • Start the consultation without verification
  • Tell woman to calm down
  • Αλληλούχιση Γονιδιώματος
  • Emergency Department
  • It is advisable to start aspirin rather than warfarin
  • Option 3
  • Ενίσχυση DNA
  • Ignore the wound complaint and focus solely on blood glucose.
  • There is a different underlying cause, not related to asthma or medication
  • Κλείνει ραντεβού με τον γενικό γιατρό
  • Station 3 - Blood pressure measurement
  • Σωστά!
  • Τεστ γαλακτώματος
  • Test de identificare a glucozei
  • Grapefruit-aspirin interaction
  • Warfarin may be commenced but LMWH is also needed initially
  • Opción 1: A y C son correctas
  • examine his dialysis effluent
  • Αιμοδυναμική αστάθεια
  • Nosebleed management
  • Metabolism and Enzymes
  • CULTIVO CELULAR
  • A, B, C
  • you will need to adjust the camera focus and sit further from camera
  • Privacy risk
  • Sinteza proteinelor
  • Ethanol
  • Amlodipine (Calcium Channel Blocker)
  • Να τον αγκαλιάσει
  • Give Surfactant via Endotracheal Tube
  • Breakfast Tuesday Morning
  • Hydrochlorothizide (thiazide diuretic)
  • The patient will be dissatisfied, and might not come to the next appointment and you will lose the follow up. You will also not have enough data about patient’s progress.
  • Node 1: Introduction
  • Γυναίκα με κοιλιακό άλγος
  • Ορισμός 1
  • Decreased levels of HDL
  • 5 year old boy with bronchial obstruction
  • ΕΞΙΤΗΡΙΟ ΜΕ ΑΝΤΙΕΠΙΛΗΤΙΚΗ ΚΑΙ ΑΠΟΙΔΗΜΑΤΙΚΗ ΑΓΩΓΗ
  • Increased secretion of insulin from the pancreas
  • Las células HeLa se cultivan fácilmente y son altamente proliferativas
  • Καλείτε την ειδική ιατρό
  • Συνεχίζει να παίρνει τα αγχολυτικά φάρμακα
  • Results
  • Give Intravenous Dexamethasone
  • 2.She should include some kind of physical activity in her daily routine
  • Tele-Physical Examination
  • Re-referral
  • Digoxin (digitalis, positive inotropic drug)
  • I don’t see you follow my instruction, do you not want to lift your left arm?
  • Go to Esspreso house
  • Τι να κάνει η Άννα?
  • It is absolutely inadvisable to commence warfarin
  • Presentation
  • Mechanism of action of GTN
  • Treatment
  • Request permission to record without explaining privacy
  • Increased LDL uptake in hepatocytes
  • A, B, E
  • Odloči se, da bo zapustil Nino in za vedno ostal z mamo.
  • Grapefruit-simvastatin interaction
  • Glyceryl trinitrate
  • Odloči se, da bo ostal sam.
  • Adverse effect to paracetamol
  • Refer to breastfeeding counselor
  • Ζητάτε εργαστηριακές εξετάσεις, ακτινογραφίες και εξηγείτε περισσότερα για τη διαχείριση του πόνου.
  • new node
  • CULTURA ȘI CREȘTEREA MICROBIANĂ
  • Glycerol trinitrate (organic nitrate)
  • ΠΕΨΗ ΤΟΥ DNA ΜΕ ΠΕΡΙΟΡΙΣΤΙΚΕΣ ΕΝΔΟΝΟΥΚΛΕΑΣΕΣ
  • Analgetics
  • Ramipril (ACE inhibitor)
  • Warfarin may be commenced as an alternative to apixaban
  • Omalizumab (IgE antibody)/Salbutamol (SABA)
  • Επίσκεψη σε ρευματολόγο
  • Root Node
  • Καλείτε την ειδική ιατρό
  • Bivalirudin (direct thrombin inhibitor)
  • Digoxin
  • Decreased absorption of dietary cholesterol
  • Salbutamol (SABA)
  • Enalapril (ACE inhibitor)
  • Lansoprazole, bismuth subsalicytate, metronidazole, and tetracycline
  • Game Over
  • Introduction to the profession and to other students
  • CELL CULTURE
  • Η ποιότητα ζωής του ασθενούς χειροτερεύει
  • Give Nurse Instruction
  • History of Present Illness
  • Root Node
  • Bedside Ultrasound Examination
  • patient at risk!
  • High Molecular Weight Heparin
  • Opțiunea 1
  • Root Node
  • Presentation

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