Case Presentation
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Transcript of Case Presentation
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Maria Febi C. BillonesJanuary 13, 2010
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R.Q. 61 y/o Female Married Bicutan
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Dyspnea
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Known diabetic x 15 years
Initially presented with 3 P’s &
weight loss
Prescribed with Glibenclamide 5mg
BID however with poor compliance
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Known hypertensive x 5 years
HBP 150/100
UBP 120/90
No medications taken
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1 year PTC patient noticed easy
fatigability usually after simple
household chores associated with
dyspnea on exertion
She also experienced occasional chest
heaviness lasting almost the whole day
aggravated by work and relieved
temporarily by rest
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3 months PTC noted worsening of
symptoms hence had herself an ECG and
Chest Xray in a nearby laboratory clinic
However, results revealed “within normal
limits” on ECG and “Atheromatous Aorta”
on Xray hence decided not to seek
medical consult
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Persistence of dyspnea as well as
easy fatigability prompted consult.
(-) cough, colds, orthopnea, PND,
edema
(-)
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(-) weight loss (-) dizziness (+) headache, occasional (+) nape pains,
occasional (-) blurring of vision (-) nausea (-) vomiting (-) abdominal pain (-) diarrhea (-) constipation
(+) polyuria (+) polydipsia (+) nocturia (-) oliguria (-) paresthesias (-) fever
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s/p Total Hysterectomy for multiple
myoma, 1978 at UDMC
s/p breast cyst excision, 1972
(-) asthma, allergy, PTB
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DiabetesPTBHypertensionSchizophreniaBrain Tumor
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previous smoker 1-2 sticks/day x 1 yr (1978)
occasional alcoholic beverage drinker College Graduate, previously worked
in a bank Eventually lost her job and currently
on financial crisis
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Nulligravid Underwent total hysterectomy for
multiple myomas at 28 y/o Menarche at 16 y/o, monthly regular
interval, 5 days duration, moderate amount, (-) dysmenorrhea
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PHYSICAL EXAMINATION
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General Survey Conscious, coherent, not in respiratory
distress Vital Signs
BP 150/90 HR 58 RR 22 Temp 37.1
Wt 70.3kg Ht 161cm BMI 27
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HEENT pink conjunctivae, anicteric sclerae, no
nasoaural discharge, no tonsillopharyngeal congestion
Neck No anterior neck mass, no cervical
lymphadenopathy, no neck vein engorgement
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Chest/Lungs Equal chest expansion, no retractions, clear
breath sounds Heart
Adynamic precordium, bradycardic, regular rhythm, distinct heart sounds, apex beat at 5th ICS LMCL, no murmur
Abdomen Flabby, (+) incision scar, infraumbilical
area, normoactive bowel sounds, soft, non-tender
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Extremities Full and equal pulses, pink nailbeds, no
edema, no cyanosis, no jaundice Neuro Exam
Awake, alert, follows commands, oriented Cranial Nerves
1 – N/A; 2 – pupils 3mm EBRTL; 3,4,6 – full & equal EOMs; 5 – brisk corneals; 7 – no facial asymmetry; 8 – intact gross hearing; 9,10 – good gag, 11 – good shoulder shrug, 12 – tongue midline
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Neuro Exam MMT – 5/5 all extremities Sensory – 100% intact DTRs - ++ Cerebellars: no dysmetria Meningeals: supple neck, no
incontinence
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t/c Chronic Stable Angina Pectoris
DM Type 2, non-insulin requiring,
Obese I
t/c DM nephropathy
Hypertension Stage 1,
uncontrolled
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Diagnostic FBS, BUN, Crea, Na, K, Cl, Ca, Mg Urinalysis 12-L ECG
Therapeutics Metformin 500mg BID Losartan 50mg OD
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Lifestyle Modification Low salt low fat diet, low protein high
fiber diet Daily BP monitoring, sugar
monitoring Refer to Ophtha
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Among diabetic patients, what is the
sensitivity and specificity of 24 hr
urine albumin vs urine micral test in
early detection of DM nephropathy?
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P – patients with diabetes
I –24 hr urine albumin vs urine micral
test
O – in early detection of DM
nephropathy
M – cross sectional studies
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Among long term diabetic patients,
which is more effective between
ACE-inhibitor and Angiotensin-
receptor blocker in delaying the
progression of diabetic
nephropathy?
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P – patients with long term diabetes (>10yrs)
I – ACE inhibitor vs ARB O – in delaying the progression of
diabetic nephropathy M – randomized control trial
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Thank you...