January bimonthly exam
26 year old woman with complaints of altered sensorium somce 1 day,headache since 8 days,fever and vomitings since 4 days
Case presentation links:
a). What is the problem representation of this patient and what is the anatomical localization for her current problem based on the clinical findings?
A 26year old female patient who is k/c/o SLE presented with complaints of headache since 8 days, fever and vomitings since 4 days and altered sensorium since 2 days.Anatomical localization - brain
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 her problems and current outcomes.
b) etiology:
CVA , TB Meningitis , SLE vasculitis ,SIADH secondary to infection.
Initially the first on-call team thought it was Hyponatremia which is causing altered sensorium.. and MRI was done which showed stroke.
the second on call team with further work up decided to do LP which showed the CSF positive for CBNAAT...thus came to the diagnosis of TB Meningitis.
c) What is the efficacy of each of the drugs listed in her prior treatment plan that she was following since last two years before she stopped it two weeks back?
For example:
Why was she given bisphosphonates?
What is the efficacy of using primary bisphosphonate prophylaxis for patients started on corticosteroids?
—to prevent risk of osteoporotic fractures
What is the efficacy of using primary PPI prophylaxis during initiation of any corticosteroids to prevent Gi ulcers?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3970554/(proton pump for corticosteroid ulcers)
d) Please share any reports around similar patients with SLE and TB meningitis?
Any reports of normal csf leukocyte count and normal csf protein in meningitis?
What could be the probable cause for a normal csf leukocyte count in a patient with chronic meningitis?
——Usage of corticosteroids can be the cause of normal cell counts
e) What is the sensitivity and specificity of ANA in the diagnosis of SLE?
2) Please go through the two thesis presentations below and answer the questions below by also discussing them with the presenters:
What was the research question in the above thesis presentation?
1–does salt restricted diet decrease BP?
2–can 24hr urinary sodium test reflect the amount of sodium consumed by an individual.?
What was the researcher's hypothesis?
—It is that salt resriction doesnt have the same effect in all the individuals in the same way
Some individuals sensitive to salt benefit from salt restriction while resistant individuals dont.
—24hr unrinary sodium is a reflection of sodium comsumed by an individual
What is the current available evidence for magnesium deficiency leading to poorer outcomes in patients with diabetes?
What was the research question in the above thesis presentation?
—research question was that If magnesium deficiency has a role in leading to complications in patients with diabetes
What was the researcher's hypothesis?
—-hypomagnesemia leads to complications in patients with DM2
What is the current available evidence for the utility of monitoring salt excretion in the hypertensive population?
3) Please critically appraise the full text article linked below:
What is the efficacy of aspirin in stroke in your assessment of the evidence provided in the article. Please go through the RCT CASP checklist here https://casp-uk.net/casp-
Amongst aspirin‐treated patients, stroke progression occurred in 15.9% as compared with 16.7% in the placebo group, which is less frequent than expected. The relative risk was 0.95 (95% CI 0.62–1.45) in the treatment group. As regards patient outcome at discharge and after 3 months, aspirin treatment did not show any difference.
2-the randomisation eliminated any bias
3-the participants and investigators were blind
4-the study groups were similar
4) Please mention your individual learning experiences from this month
1–learnt the clinical examination of all the systems
2–inspected amd learnt about locomotor brachii in the following patient
3-learnt about the conduction system of the heart and the blood supply of the heart and about the ecg changes in AFB
4-learnt about detailed clinical examination of CLD
5-Assissted in the procedure-central line during nephrology posting
6- learnt and witnessed pericardiocentesis performed for the following patient
Learnt about 2D ECHO changes in the above patient
7-learnt about effect of magnesium deficiency on diabetes from the research presentation
8-learnt to do an ascitic tap
5) a) What are the possible reasons for the 36 year old man's hypertension and CAD described in the link below since three years?
—From the history the probable cause could be smoking and alcohol consumption
b) Please describe the ECG changes and correlate them with the patient's current diagnosis.
— The ecg suggests:
1st ecg-irregularly irregular rythm,normal axis,
Intermittent broad qrs complexes
Rest —poor r wave progression with regular rythmn
c) Share an RCT that provides evidence for the efficacy of primary PTCA in acute myocardial infarction over medical management. Describe the efficacy in a PICO format.
It was during my research on HIV/Herpes/Diabetes that I stumbled upon the Hiv/Herpes/diabetes information; information which is quite easy to find when doing a search for STD on google. I was into conspiracy at the time and thought of HIV/Herpes Cured' being a conspiracy was something ignorant though,I found it pretty interesting about Dr Itua herbal medicine. I asked questions about the Herbal cure's on official HIV/Herpes/diabetes websites and I was banned for doing so by moderators who told me that I was parroting Hiv/Herpes propaganda. This reinforced my belief that there is a cure for Hiv/Herpes/diabetes Then i found a lady from germany name Achima Abelard Dr Itua Cure her Hiv/diabetes so I send him a mail about my situation then talk more about it and send me his herbal medicine I drank for two weeks.And today I'm Cured no Hiv/Herpes/diabetes in my life,I searched for Hiv/Herpes groups to attempt to make contact with people in order to learn more about Hiv/Herpes Herbal Cure I believed at this time that you with the same disease this information is helpful to you and I wanted to do the best I could to spread this information in the hopes of helping other people.That Dr Itua cure Hiv,Herpes,Hepatitis,Diabetes, Neuromuscular Diseases Copd,Fibroid,Als, And Cancer. He's a herbal doctor with a unique heart of God, Contact Emal..drituaherbalcenter@gmail.com www.drituaherbalcenter.com
ReplyDelete