Case:1
50 year man, he presented with the complaints of
Frequently walking into objects along with frequent falls since 1.5 years
Drooping of eyelids since 1.5 years
Involuntary movements of hands since 1.5 years
Talking to self since 1.5 years
More here:
Case presentation links:
a). What is the problem representation of this patient and what is the anatomical localization for his current problem based on the clinical findings?
Problem presentation:
A 50 year old male diabetic farmer by occupation who had an episode of seizure 10 yrs back presented with c/o frequently walking into objects along with frequent falls,Drooping of eyelids,Involuntary movements of hands & Talking to self since 1.5 years was diagnosed with progressive supranuclear palsy.
Anatomical localization:
Brain
B/l ptosis : weakness of levator palbebral superioris
(without loss of frowning)
self talk
b) What is the etiology of the current problem and how would you as a member of the treating team arrive at a diagnosis? Please chart out the sequence of events timeline between the manifestations of each of his problems and current outcomes.
Etiology:Progressive supranuclear palsy: etiology is likely due to accumulation of 'tau' protein in brain
c) What is the efficacy of each of the drugs listed in his current treatment plan
Quetiapine:
Quetiapine in the treatment of psychosis in Parkinson’s disease
Syndopa : it is a prodrug , which gets converted into dopamine by enzyme dopa decarboxylase ...Which compensates the depleted dopamine levels
The severity of parkinsonism increased more in the placebo group than in all the groups receiving levodopa: the mean difference between the total score on the parkinson's Disease Rating Scale (UPDRS) at baseline and at 42 weeks was 7.8 units in the placebo group, 1.9 units in the group receiving levodopa at a dose of 150 mg daily, 1.9 in those receiving 300 mg daily, and –1.4 in those receiving 600 mg daily (P<0.00
Case:2
Patient was apparently asymptomatic 2 years back then he developed weakness in the right upper and lower limb, loss of speech.
More here:
Case presentation links:
a). What is the problem representation of this patient and what is the anatomical localization for his current problem based on the clinical findings?
Problem presentation:
60 year old male non diabetic & non hypertensive who had a history of CVA 2 years back now presented with c/o SOB,pedal edema,decreased urine output & generalized weakness since 2 months.
Anatomical localization:
Heart - HFrEF secondary to CAD
b) What is the etiology of the current problem and how would you as a member of the treating team arrive at a diagnosis? Please chart out the sequence of events timeline between the manifestations of each of his problems and current outcomes.
Etiology:
Coronary artery disease (?Cardio cerebral infarction)
Ecg showing:
1)normal axis
2)pathological Q waves from v1 to v6
3)poor R wave progression
c) What is the efficacy of each of the drugs listed in his current treatment plan
Salt and fluid restriction
Ninety-seven stable patients in NYHA class II-IV, on optimal medication, with previous signs of fluid retention, treated with either >40 mg (NYHA III-IV) or >80 mg (NYHA II-IV) of furosemide daily were randomized to either individualized salt and fluid restriction or information given by the nurse-led heart failure clinics, e.g. be aware not to drink too much and use salt with caution, and followed for 12 weeks. Fluid was restricted to 1.5 L and salt to 5 g daily, and individualized dietary advice and support was given.
Results After 12 weeks, significantly more patients in the intervention than in the control group improved on the composite endpoint (51% vs. 16%; P < 0.001), mostly owing to improved NYHA class and leg oedema. No negative effects were seen on thirst, appetite, or QoL
Benfomet as thiamine replacement in alcoholic patients
Benfomet increases the action of transketolase and decreases the end glycation products
It can act as replacement of Thaimine which is essential for transketolase activity
Especially in alcoholics
Aldactone(spironolactone)
Based on earlier work suggesting a benefit of therapy,2 the Randomized Aldactone Evaluation Study (RALES) was undertaken to evaluate the role of spironolactone when used in addition to standard therapy for CHF.
Case:3
52 year old male , shopkeeper by profession complains of SOB, cough ,decrease sleep and appetite since 10 days and developed severe hyponatremia soon after admission.
Morehere:
Case presentation video:
a) What is the problem representation of this patient and what is the anatomical localization for his current problem based on the clinical findings?
Problem presentation:
A 52 year old male shopkeeper known diabetic & hypertensive presented with c/o SOB,cough,decreased sleep&appetite diagnosed with dimorphic anemia & dyselectrolytemia
Anatomical localization:
Anemia - Bone marrow
Hyponatremia - ? SIADH
b) What is the etiology of the current problem and how would you as a member of the treating team arrive at a diagnosis? Please chart out the sequence of events timeline between the manifestations of each of his problems and current outcomes.
Etiology:
Dimorphic anemia secondary to ? Nutritional
Hyponatremia secondary to free fluid (dilutional) - poor sugar control (hyperglycemia)
I would rather give lasix and avoid giving fluids as he is having heart failure and hyponatremia which further aggrevates by giving free fluid
c) What is the efficacy of each of the drugs listed in his current treatment plan especially for his hyponatremia? What is the efficacy of Vaptans over placebo? Can one give both 3% sodium as well as vaptan to the same patient?
No role in giving monocef & metrogyl
Vaptans:
Vaptans are vasopressin antagonists that interfere with the antidiuretic effect of the hormone by competitively binding to V2 receptors in the kidney.
They can be used as an alternative to fluid restriction
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| 4) Please mention your individual learning experiences from this month. |
- A case of ? Broncho-alveolar carcinoma--Lung biopsy - turned out to be organizing pneumonia
- A case of Celiac disease--response to gluten free diet with superimposed giardiasis
- A case of Budd chiari syndrome
- A case of severe PAH secondary to PTB--lung fibrosis--cor pulmonale
- Rapidly filling ascites
- Renal transplant prospects
