Pharmacology case studies
The following case studies will test the knowledge acquired in your pharmacology tutorials on this website. Have a go at answering the accompanying questions based on the case study. Please roll the cursor over the text boxes to reveal the answers or alternatively download the answer sheet.
45-year-old male c/o facial pain, worse on left side. He has been complaining of cold-like symptoms with a blocked nose and rhinorrhoea for a week, which initially seemed to improve, however then worsened again. He now complains of thicker, green, nasal discharge predominantly on left with some anosmia and facial pain over the last week.
a) What is the likely diagnosis?
b) How would you manage the patient?
c) What lifestyle advice would you give?
The above patient represents 2 months later and still feels his nose is blocked, with his sense of smell and taste still ‘not right’. The face is tender rather than painful, and less discharge than there was. He has been using decongestant nasal spray intermittently, with no real improvement.
a) What is the likely diagnosis now?
b) What changes to the current management would you suggest?
A 9-year-old presents with a two-day history of left sided otalgia. There is no otorrhoea, but the patient does find the hearing is muffled.
DHx: Becotide INH 50 two puffs bd, salbutamol INH PRN. Allergies: Penicillin (rash)
On examination, the tympanic membrane is intact and not bulging but is slightly dull. No vomiting, no rash but feeling more lethargic. The child is otherwise, fit and well, eating and drinking.
Temp 37.2C with all other observations normal.
The child was given two doses of paracetamol previous day with some relief.
You make a diagnosis of acute otitis media.
a) Would you prescribe any antibiotics?
b) What are the drawbacks of prescribing antibiotics?
c) What advice would you offer?
An 18-month-old presents with a one-day history of bilateral otalgia.
On examination, both membranes bulging but no otorrhoea, temp 39.4C. No rash, no vomiting, more lethargic and off food a little but drinking milk and water. Some discomfort on examination. Has had a cold last few days and still has rhinorrhoea.
a) How would you manage the patient?
b) What are the red flags associated with this condition?
38-year-old female with unilateral itchy, uncomfortable ear. She has been using Earcalm for last 7 days, bought OTC with no real improvement. She does not, however, complain of hearing loss.
PMH: eczema, constipation, pregnant 32/40 weeks gestation
DHx: hydrocortisone 0.1% cream BD PRN, Eumovate cream BD PRN if needed, lactulose.
On examination; The ear canal erythematous and eczematous. You are unable to visualise the tympanic membrane fully, but there is no discharge. The patient complains of some discomfort on examination and on opening her mouth wide.
Apyrexial, no systemically illness.
a) What is the likely diagnosis?
b) What, if anything, would you prescribe?
c) What other advice would you give?
72-year-old male presents with two episodes of dizziness within the last two weeks; struggling to keep his balance and feeling nauseated when this happens. The last episode lasted nearly 2 hours.
His symptoms are; unilateral ear fullness, tinnitus and hearing loss and these symptoms come on with his vertigo.
PMH: Enlarged prostate, urinary frequency and depression since wife passed away 1 year ago.
DHx: Tamsulosin 400mcg od, citalopram 20mg od.
Otoneurological examination is unremarkable.
a) What is the most likely diagnosis?
b) What is your management in this case?
c) What would your next course of action be?
d) What further tests do you think should be conducted?
e) Would you give any further advice on triggers and safety factors?
Written in association with Helena Dunne