GENERAL MEDICINE CASE DISCUSSION

Surigi Mounika 160

Date : 16/05/2020  

WOMEN WITH MULTIPLE HEALTH PROBLEMS SINCE BIRTH 

I have been given this case to solve in an attempt to understand the topic of "patient clinical data analysis"to develope my competency in reading and comprehending clinical data including history taking, clinical findings, investigations ,diagnosis and treatment. 

You can find entire real patient clinical problem in this linkhttps://classworkdecjan.blogspot.com/2019/05/42-f-with-severe-regular-edema-with_17.html?m=

Following is my analysis of this patient's problem:

The problem in order of priority I found are 

1 SEVERE HEAD ACHE 

2.swelling 

3.muscle weakness 

4.sensory processing disorder 

5.Mouth ulcers 

6.Excessive hair growth 

                

            SEVERE HEADACHE 

Onset:sudden 

Duration:2years

Associated with aura before headache: rainbow colours,blindness 

Left side hand numbness 

Ataxia( Leftside)

Vertigo

Stuttering of speech and sleep disturbance.

Aggravating with:

1.stress 

2.menses 

3.OC pills.

4.one episode of nasal discharge for about 10 mins on bending forward 

 DIAGNOSIS:

HEMIPLEGIA MIGRAIN. 

Factors responsible for this condition are

.Stress 

.less sleep 

.Excess exercise 

.Avoiding meals

.oc pills

.travel history 

. Smoke

INVESTIGATIONS:

Funds examination 

CT and MRI 

DOPPLER 

Xray paranasal sinuses

                                  

 TREATMENT:                                

Triptans.

ERENUMAB(CGRP INHIBITOR)

         

                SWELLING 

Onset:at age 1 year 

Duration: still present 

Aggravating factors:

         Emotional stress 

          Smoke 

         Eating wrong food 

          Physical activity 

          Antimalarials 

           Fava beans

           Sulfa drugs 

Mainly in face , neck and abdomen. 

DIAGNOSIS: 

It may be associated with G6PD deficiency ( Hemolytic crisis)

FACTORS TRIGGERS IN THIS PATIENT:

            Infection: recurrent UTI and 

                                Pneumonia. 

             Antimalarials 

             Sulfa drugs

              Fava beans 

Symptoms associated with this condition in this patient: 

Coke colour urine

Diarrhoea 

Vomiting 

Swelling 

Acute kidney failure. 

EXAMINATION:

.Any episode of jundice

.hemolysis conditions. 

INVESTIGATIONS:

CBP

Liver enzymes

Reticulocyte counts 

Bilirubin levels 

 Haptoglobin level 

Coombs test (negative in this case)

BEUTLER FLORESCENT SPOT TEST

Peripheral smear: bite cells , Blister cells ,HEINZ bodies. 

TREATMENT: 

Avoid oxidative stress 

Vaccination against pneumonia 

Blood transfusion

Apple ( anti oxidant property).

MUSCLE WEAKNESS:

AMPD1 deficiency

                   |

Excess adenosine 

                    |

Decreased altertness and fatigue

                      Muscle weakness 

Treatment:

Ribose.

 SENSORY PROCESSING DISORDER:Numbness in left side of face and loss of function of left side. 

Associated with migrane attack

DIAGNOSIS: Hemiplegic migraine.

OTHER PROBLEMS: 

Mouth ulcers 

Vaginal ulcers 

Blurring of vision 

Long term knee and hip pain

Differential diagnosis:

SLE

Behcets disease 

INVESTIGATIONS

 Antibodies testing forSLE

BLOOD tests 

Genetic testing 

Allergy testing 

Pathergy test

Treatment:

1.Corticosteroids 

2.Colchicine 

3.Immunosuppressants

EXCESSIVE HAIR GROWTH :

On face, neck, toes,legs in 4 years

D/D

1.PCOS 

2.congenital adrenal hyperplasia 

INVESTIGATIONS 

1.CT scan for PCOS 

2.cortisol levels

TREATMENT:

Spironolactone 

Anti androgens

Eflornithine

Eletrolysis