Jenny received a circular from Beauty and the Beast Hair Salon advertising massages and

manicures for $10. Realising that this was an exceptionally good deal, but not surprised

because she knew that they had only just opened and were running a number of good

opening specials, she rang and made a booking. When Jenny arrived at the salon she was

told that there had been a mistake on the circular and it should have said $100. The

manager of the salon explained that this was still a good price because normally a

massage and manicure would have cost $150. Jenny was furious, as it had taken her 30

minutes to get to the shop by car and if she had known it would cost $100, she would

never have made the booking. Advise Jenny. Would your advice have been any different if

Jenny had the massage and manicure before being told that the cost was $100? Would

she have to pay the full price?

Question 113 Can sublingual nifedipine be given to a patient with malignant hypertension/accelerated hypertension? It seems to be a controversial issue with some favouring it and some against it. Question 114 Is the diagnosis of malignant hypertension based only on the basis of the retinopathy (even in the presence of a normotensive state)? Labetalol, parenterally, is suggested as a treatment for malignant hypertension. What other more readily available preparations (besides sodium nitroprusside) are recommended in addition to this drug? Parental labetalol is not available in Pakistan! Question 115 Patients at medium risk of DVT and pulmonary embolism are usually given specific prophylaxis with low-dose heparin at a dose of 5000 units subcutaneously every 8-12 hours until the patient is ambulatory. Is the 13 Cardiovascular disease 132 first dose given immediately after, say, extensive varicose vein surgery of small and great saphenous veins? Question 116 'Anticoagulants are not necessary, as embolism does not occur from superficial thrombophlebitis' (K&C 7e, p. 809). Why? Question 117 Can we use enoxaparin for deep vein thrombosis (DVT) prophylaxis in the immediate postoperative period and in a case of cerebral haemorrhage? Wouldn't it increase the risk of haemorrhage in either case? Question 118 Can external jugular vein thrombosis cause tingling numbness over the earlobe and adjoining part of the lower face? Question 119 For how long does a patient have to stay in bed to be labelled as bedridden and to merit low-molecular-weight heparin (LMWH) as prophylaxis for deep vein thrombosis? Question 120 Is an inferior vena cava filter an alternative treatment for a patient with a history of recurrent deep vein thrombosis on lifelong anticoagulation with warfarin? Question 121 Can you explain why a decrease in serum lipid levels follows an acute myocardial infarction (MI)? For how long does this decrease last and how is it known whether the patient has hyperlipidaemia in such a case? Question 122 In patients with myocardial infarction, why is aspirin to be taken chewed, and not by any other method? Question 123 Must beta-blockers prescribed for hypertension be stopped if the heart rate falls below 60 beats per minute?